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Wu LY, Chai YL, Cheah IK, Chia RSL, Hilal S, Arumugam TV, Chen CP, Lai MKP. Blood-based biomarkers of cerebral small vessel disease. Ageing Res Rev 2024; 95:102247. [PMID: 38417710 DOI: 10.1016/j.arr.2024.102247] [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: 04/10/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Age-associated cerebral small vessel disease (CSVD) represents a clinically heterogenous condition, arising from diverse microvascular mechanisms. These lead to chronic cerebrovascular dysfunction and carry a substantial risk of subsequent stroke and vascular cognitive impairment in aging populations. Owing to advances in neuroimaging, in vivo visualization of cerebral vasculature abnormities and detection of CSVD, including lacunes, microinfarcts, microbleeds and white matter lesions, is now possible, but remains a resource-, skills- and time-intensive approach. As a result, there has been a recent proliferation of blood-based biomarker studies for CSVD aimed at developing accessible screening tools for early detection and risk stratification. However, a good understanding of the pathophysiological processes underpinning CSVD is needed to identify and assess clinically useful biomarkers. Here, we provide an overview of processes associated with CSVD pathogenesis, including endothelial injury and dysfunction, neuroinflammation, oxidative stress, perivascular neuronal damage as well as cardiovascular dysfunction. Then, we review clinical studies of the key biomolecules involved in the aforementioned processes. Lastly, we outline future trends and directions for CSVD biomarker discovery and clinical validation.
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Affiliation(s)
- Liu-Yun Wu
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yuek Ling Chai
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Irwin K Cheah
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore
| | - Rachel S L Chia
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Saima Hilal
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Kent Ridge, Singapore
| | - Thiruma V Arumugam
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea; Centre for Cardiovascular Biology and Disease Research, Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Christopher P Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mitchell K P Lai
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Hosoki S, Hansra GK, Jayasena T, Poljak A, Mather KA, Catts VS, Rust R, Sagare A, Kovacic JC, Brodtmann A, Wallin A, Zlokovic BV, Ihara M, Sachdev PS. Molecular biomarkers for vascular cognitive impairment and dementia. Nat Rev Neurol 2023; 19:737-753. [PMID: 37957261 DOI: 10.1038/s41582-023-00884-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/15/2023]
Abstract
As disease-specific interventions for dementia are being developed, the ability to identify the underlying pathology and dementia subtypes is increasingly important. Vascular cognitive impairment and dementia (VCID) is the second most common cause of dementia after Alzheimer disease, but progress in identifying molecular biomarkers for accurate diagnosis of VCID has been relatively limited. In this Review, we examine the roles of large and small vessel disease in VCID, considering the underlying pathophysiological processes that lead to vascular brain injury, including atherosclerosis, arteriolosclerosis, ischaemic injury, haemorrhage, hypoperfusion, endothelial dysfunction, blood-brain barrier breakdown, inflammation, oxidative stress, hypoxia, and neuronal and glial degeneration. We consider the key molecules in these processes, including proteins and peptides, metabolites, lipids and circulating RNA, and consider their potential as molecular biomarkers alone and in combination. We also discuss the challenges in translating the promise of these biomarkers into clinical application.
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Affiliation(s)
- Satoshi Hosoki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Gurpreet K Hansra
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tharusha Jayasena
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Anne Poljak
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Vibeke S Catts
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ruslan Rust
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abhay Sagare
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason C Kovacic
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, NY, USA
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Amy Brodtmann
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Weng XF, Liu SW, Li M, Zhang Y, Zhang YC, Liu CF, Zhu JT, Hu H. Relationship between sarcopenic obesity and cognitive function in patients with mild to moderate Alzheimer's disease. Psychogeriatrics 2023; 23:944-953. [PMID: 37652079 DOI: 10.1111/psyg.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Previous research has linked sarcopenic obesity (SO) to cognitive function; however, the relationship between cognitive performance and SO Alzheimer's disease (AD) patients remains unclear. This study aimed to investigate their relationship in AD patients. METHODS One hundred and twenty mild to moderate AD patients and 56 normal controls were recruited. According to sarcopenia or obesity status, AD patients were classified into subgroups: normal, obesity, sarcopenia, and SO. Body composition, demographics, and sarcopenia parameters were assessed. Cognitive performance was evaluated using neuropsychological scales. RESULTS Among the 176 participants, the prevalence of SO in the moderate AD group was higher than in the normal control group. The moderate AD group had the lowest appendicular skeletal muscle mass index (ASMI) and the highest percentage of body fat (PBF). Hypertension and diabetes were more prevalent in the SO group than in the normal group among the subgroups. The sarcopenia and SO groups exhibited worse global cognitive function compared to the normal and obesity groups. Partial correlation analysis revealed that ASMI, PBF, and visceral fat area were associated with multiple cognitive domains scores. In logistic regression analysis, after adjusting for confounders, obesity was not found to be associated with AD. However, sarcopenia (odds ratio (OR) = 5.35, 95% CI: 1.27-22.46) and SO (OR = 5.84, 95% CI: 1.26-27.11) were identified as independent risk factors for AD. CONCLUSIONS SO was associated with cognitive dysfunction in AD patients. Moreover, the impact of SO on cognitive decline was greater than that of sarcopenia. Early identification and intervention for SO may have a positive effect on the occurrence and progression of AD.
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Affiliation(s)
- Xiao-Fen Weng
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Geriatric Medicine, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Shan-Wen Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng Li
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Zhang
- School of Life Sciences and Technology, Changchun University of Science and Technology, Changchun, China
| | - Ying-Chun Zhang
- Department of Ultrasonography, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang-Tao Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hua Hu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Meade CS, Bell RP, Towe SL, Lascola CD, Al‐Khalil K, Gibson MJ. Cocaine use is associated with cerebral white matter hyperintensities in HIV disease. Ann Clin Transl Neurol 2023; 10:1633-1646. [PMID: 37475160 PMCID: PMC10502656 DOI: 10.1002/acn3.51854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND White matter hyperintensities (WMH), a marker of cerebral small vessel disease and predictor of cognitive decline, are observed at higher rates in persons with HIV (PWH). The use of cocaine, a potent central nervous system stimulant, is disproportionately common in PWH and may contribute to WMH. METHODS The sample included of 110 PWH on antiretroviral therapy. Fluid-attenuated inversion recovery (FLAIR) and T1-weighted anatomical MRI scans were collected, along with neuropsychological testing. FLAIR images were processed using the Lesion Segmentation Toolbox. A hierarchical regression model was run to investigate predictors of WMH burden [block 1: demographics; block 2: cerebrovascular disease (CVD) risk; block 3: lesion burden]. RESULTS The sample was 20% female and 79% African American with a mean age of 45.37. All participants had persistent HIV viral suppression, and the median CD4+ T-cell count was 750. Nearly a third (29%) currently used cocaine regularly, with an average of 23.75 (SD = 20.95) days in the past 90. In the hierarchical linear regression model, cocaine use was a significant predictor of WMH burden (β = .28). WMH burden was significantly correlated with poorer cognitive function (r = -0.27). Finally, higher WMH burden was significantly associated with increased serum concentrations of interferon-γ-inducible protein 10 (IP-10) but lower concentrations of myeloperoxidase (MPO); however, these markers did not differ by COC status. CONCLUSIONS WMH burden is associated with poorer cognitive performance in PWH. Cocaine use and CVD risk independently contribute to WMH, and addressing these conditions as part of HIV care may mitigate brain injury underlying neurocognitive impairment.
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Affiliation(s)
- Christina S. Meade
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth Carolina27710USA
| | - Ryan P. Bell
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Sheri L. Towe
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Christopher D. Lascola
- Brain Imaging and Analysis CenterDuke University Medical CenterDurhamNorth Carolina27710USA
- Department of RadiologyDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Kareem Al‐Khalil
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
| | - Matthew J. Gibson
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth Carolina27710USA
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Jaime Garcia D, Chagnot A, Wardlaw JM, Montagne A. A Scoping Review on Biomarkers of Endothelial Dysfunction in Small Vessel Disease: Molecular Insights from Human Studies. Int J Mol Sci 2023; 24:13114. [PMID: 37685924 PMCID: PMC10488088 DOI: 10.3390/ijms241713114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Small vessel disease (SVD) is a highly prevalent disorder of the brain's microvessels and a common cause of dementia as well as ischaemic and haemorrhagic strokes. Though much about the underlying pathophysiology of SVD remains poorly understood, a wealth of recently published evidence strongly suggests a key role of microvessel endothelial dysfunction and a compromised blood-brain barrier (BBB) in the development and progression of the disease. Understanding the causes and downstream consequences associated with endothelial dysfunction in this pathological context could aid in the development of effective diagnostic and prognostic tools and provide promising avenues for potential therapeutic interventions. In this scoping review, we aim to summarise the findings from clinical studies examining the role of the molecular mechanisms underlying endothelial dysfunction in SVD, focussing on biochemical markers of endothelial dysfunction detectable in biofluids, including cell adhesion molecules, BBB transporters, cytokines/chemokines, inflammatory markers, coagulation factors, growth factors, and markers involved in the nitric oxide cascade.
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Affiliation(s)
- Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Audrey Chagnot
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Axel Montagne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
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Snyder A, Grant H, Chou A, Lindbergh CA, Kramer JH, Miller BL, Elahi FM. Immune cell counts in cerebrospinal fluid predict cognitive function in aging and neurodegenerative disease. Alzheimers Dement 2023; 19:3339-3349. [PMID: 36791265 PMCID: PMC10425564 DOI: 10.1002/alz.12956] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Immune dysfunction is important in aging and neurodegeneration; lacking clinically available tools limits research translation. We tested associations of cerebral spinal fluid (CSF) monocyte-to-lymphocyte ratio (MLR)-innate immune activation surrogate-with cognition in an aging and dementia cohort, hypothesizing that elevated MLR is associated with poorer executive functioning. METHODS CSF MLR was calculated in well-characterized, genotyped participants enrolled in studies of aging and dementia at University of California, San Francisco Memory and Aging Center (n = 199, mean age 57.5 years, SD 11.9). Linear models tested associations with episodic memory and executive function (verbal fluency, speeded set-shifting). RESULTS Aging was associated with higher CSF monocyte, lower lymphocyte counts, and higher MLRs (p < 0.001). MLR was associated with verbal fluency (p < 0.05) only. DISCUSSION Using clinical labs, we show an inverse association between CSF MLR and executive function in aging and dementia, supporting the utility of clinical labs in capturing associations between innate immune dysfunction and neurodegeneration.
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Affiliation(s)
- Allison Snyder
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Harli Grant
- Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Austin Chou
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Cutter A Lindbergh
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Joel H Kramer
- Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Bruce L Miller
- Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Fanny M Elahi
- Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
- Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Yang Z, He M, Zhang Q, Li S, Chen H, Liao D. Exploring the bi-directional relationship and shared genes between depression and stroke via NHANES and bioinformatic analysis. Front Genet 2023; 14:1004457. [PMID: 37065487 PMCID: PMC10102600 DOI: 10.3389/fgene.2023.1004457] [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: 07/27/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Stroke and depression are the two most common causes of disability worldwide. Growing evidence suggests a bi-directional relationship between stroke and depression, whereas the molecular mechanisms underlying stroke and depression are not well understood. The objectives of this study were to identify hub genes and biological pathways related to the pathogenesis of ischemic stroke (IS) and major depressive disorder (MDD) and to evaluate the infiltration of immune cells in both disorders. Methods: Participants from the United States National Health and Nutritional Examination Survey (NHANES) 2005-2018 were included to evaluate the association between stroke and MDD. Two differentially expressed genes (DEGs) sets extracted from GSE98793 and GSE16561 datasets were intersected to generate common DEGs, which were further screened out in cytoHubba to identify hub genes. GO, KEGG, Metascape, GeneMANIA, NetworkAnalyst, and DGIdb were used for functional enrichment, pathway analysis, regulatory network analysis, and candidate drugs analysis. ssGSEA algorithm was used to analyze the immune infiltration. Results: Among the 29706 participants from NHANES 2005-2018, stroke was significantly associated with MDD (OR = 2.79,95% CI:2.26-3.43, p < 0.0001). A total of 41 common upregulated genes and eight common downregulated genes were finally identified between IS and MDD. Enrichment analysis revealed that the shared genes were mainly involved in immune response and immune-related pathways. A protein-protein interaction (PPI) was constructed, from which ten (CD163, AEG1, IRAK3, S100A12, HP, PGLYRP1, CEACAM8, MPO, LCN2, and DEFA4) were screened. In addition, gene-miRNAs, transcription factor-gene interactions, and protein-drug interactions coregulatory networks with hub genes were also identified. Finally, we observed that the innate immunity was activated while acquired immunity was suppressed in both disorders. Conclusion: We successfully identified the ten hub shared genes linking the IS and MDD and constructed the regulatory networks for them that could serve as novel targeted therapy for the comorbidities.
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Affiliation(s)
- Zhanghuan Yang
- Department of Oncology, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Maokun He
- Hainan Medical University, Haikou, China
| | - Qian Zhang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, Hunan, China
| | - Hua Chen
- Department of Neurosurgery, The First people’s Hospital of Changde, Changde, China
| | - Di Liao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Wan S, Dandu C, Han G, Guo Y, Ding Y, Song H, Meng R. Plasma inflammatory biomarkers in cerebral small vessel disease: A review. CNS Neurosci Ther 2022; 29:498-515. [PMID: 36478511 PMCID: PMC9873530 DOI: 10.1111/cns.14047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a group of pathological processes affecting small arteries, arterioles, capillaries, and small veins of the brain. It is one of the most common subtypes of cerebrovascular diseases, especially highly prevalent in elderly populations, and is associated with stroke occurrence and recurrence, cognitive impairment, gait disorders, psychological disturbance, and dysuria. Its diagnosis mainly depends on MRI, characterized by recent small subcortical infarcts, lacunes, white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVS), cerebral microbleeds (CMBs), and brain atrophy. While the pathophysiological processes of CSVD are not fully understood at present, inflammation is noticed as playing an important role. Herein, we aimed to review the relationship between plasma inflammatory biomarkers and the MRI features of CSVD, to provide background for further research.
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Affiliation(s)
- Shuling Wan
- Department of Neurology, National Center for Neurological Disorders, Xuanwu HospitalCapital Medical UniversityBeijingChina,Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Chaitu Dandu
- Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
| | - Guangyu Han
- Department of Neurology, National Center for Neurological Disorders, Xuanwu HospitalCapital Medical UniversityBeijingChina,Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Yibing Guo
- Department of Neurology, National Center for Neurological Disorders, Xuanwu HospitalCapital Medical UniversityBeijingChina,Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Yuchuan Ding
- Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
| | - Haiqing Song
- Department of Neurology, National Center for Neurological Disorders, Xuanwu HospitalCapital Medical UniversityBeijingChina,Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Ran Meng
- Department of Neurology, National Center for Neurological Disorders, Xuanwu HospitalCapital Medical UniversityBeijingChina,Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina,Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
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9
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Ren B, Tan L, Song Y, Li D, Xue B, Lai X, Gao Y. Cerebral Small Vessel Disease: Neuroimaging Features, Biochemical Markers, Influencing Factors, Pathological Mechanism and Treatment. Front Neurol 2022; 13:843953. [PMID: 35775047 PMCID: PMC9237477 DOI: 10.3389/fneur.2022.843953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/12/2022] [Indexed: 01/15/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is the most common chronic vascular disease involving the whole brain. Great progress has been made in clinical imaging, pathological mechanism, and treatment of CSVD, but many problems remain. Clarifying the current research dilemmas and future development direction of CSVD can provide new ideas for both basic and clinical research. In this review, the risk factors, biological markers, pathological mechanisms, and the treatment of CSVD will be systematically illustrated to provide the current research status of CSVD. The future development direction of CSVD will be elucidated by summarizing the research difficulties.
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Affiliation(s)
- Beida Ren
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Chinese Medicine Key Research Room of Brain Disorders Syndrome and Treatment of the National Administration of Traditonal Chinese Medicine, Beijing, China
| | - Ling Tan
- Department of Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuebo Song
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Danxi Li
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Chinese Medicine Key Research Room of Brain Disorders Syndrome and Treatment of the National Administration of Traditonal Chinese Medicine, Beijing, China
| | - Bingjie Xue
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
- Chinese Medicine Key Research Room of Brain Disorders Syndrome and Treatment of the National Administration of Traditonal Chinese Medicine, Beijing, China
| | - Xinxing Lai
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
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10
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Elkind MSV. From the Heart to the Brain: Building Bridges to a Better Future. Stroke 2022; 53:1037-1042. [PMID: 35012329 PMCID: PMC8885844 DOI: 10.1161/strokeaha.121.036763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This Presidential Address was delivered at the International Stroke Conference in March 2021, during the coronavirus pandemic. Dr Elkind, the President of the American Heart Association (AHA) at the time, is a vascular neurologist with a research focus on stroke epidemiology. This address interweaves personal reflections on a career in clinical neurology, stroke research, and public health with a discussion of the role of the AHA in improving cardiovascular health at multiple levels. Throughout its history, the AHA has had leaders representing many different areas of cardiovascular science and medicine, including stroke. More recently, its focus has expanded from a traditional emphasis on cardiovascular events illness and events, like heart disease and stroke, to an appreciation of the role of the vascular system in brain health, healthy aging, cognitive decline, and dementia. During the pandemic, as the bidirectional effects of the coronavirus on cardiovascular disease has been elucidated, the benefits of a broad and multidisciplinary approach to cardiovascular disease and public health have become more apparent than ever. In addition, with growing awareness of the disproportionate effects of the pandemic on communities of color in the United States and globally, the AHA has redoubled its focus on addressing the social determinants of health, including structural racism. Central to these efforts is the construction of bridges between the generation of scientific knowledge and action for the public good. Our success will depend on the combination of basic, translational, clinical and population research with programs of public and professional education, advocacy, and social action.
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Affiliation(s)
- Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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11
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Dietary fatty acids affect learning and memory ability via regulating inflammatory factors in obese mice. J Nutr Biochem 2022; 103:108959. [PMID: 35158028 DOI: 10.1016/j.jnutbio.2022.108959] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE High-fat diets are linked to obesity, contributing to the alterations in inflammatory signaling pathways, which is associated with cognitive function. We aim to investigate the mechanisms by which various different types of dietary fatty acids affecting cognitive function in obese mice through the gut/brain axis-inflammatory signaling pathway. METHODS AND RESULTS Eight-week-old male C57BL/6 mice were fed with basal diet (control group), lard high-fat diet (containing long-chain saturated fatty acid (LCSFA group)), coconut oil high-fat diet (containing medium-chain saturated fatty acid (MCSFA group)), linseed oil high-fat diet (containing n-3 polyunsaturated fatty acid (n-3 PUFA group)), soybean oil high-fat diet (containing n-6 polyunsaturated fatty acid (n-6 PUFA group)), olive oil high-fat diet (containing monounsaturated fatty acid (MUFA group)) and 8% hydrogenated soybean oil high-fat diet (containing trans fatty acid (TFA group)) respectively for 16 weeks. Our results revealed that the mean escape latency was significantly prolonged in LCSFA group, and the latency to cross the platform location of n-6 PUFA and TFA groups were increased significantly. The differences of inflammatory markers and toll-like receptor-myeloid differentiation factor-88-nuclear factor kappa-B (TLR-MyD88-NF-κB) inflammatory signaling pathway expressions among all groups reached statistical significances. CONCLUSION Compared to basal diet, high-fat diets enriched in LCSFA, MCSFA, n-6 PUFA, MUFA, and TFA might exert detrimental effects on cognitive function in obese mice via regulating the inflammatory markers and inflammatory signaling pathway in brain and intestine. High-fat diet enriched in n-3 PUFA might exhibit different effect on modulating inflammatory responses in different tissues and might benefit to cognitive function.
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12
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Elkind MSV, Moon M, Rundek T, Wright CB, Cheung K, Sacco RL, Hornig M. Immune markers are associated with cognitive performance in a multiethnic cohort: The Northern Manhattan Study. Brain Behav Immun 2021; 97:186-192. [PMID: 34320382 PMCID: PMC8453105 DOI: 10.1016/j.bbi.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine whether immune protein panels add significant information to correlates of cognition. BACKGROUND Immune mechanisms in vascular cognitive aging are incompletely characterized. DESIGN/METHODS A subsample of the prospective Northern Manhattan Study underwent detailed neuropsychological testing. Cognitive scores were converted into Z-scores and categorized into four domains (memory, language, processing speed, and executive function) based on factor analysis. Blood samples were analyzed using a 60-plex immunoassay. We used least absolute shrinkage and selection operator (LASSO) procedures to select markers and their interactions independently associated with cognitive scores. Linear regression models assessed cross-sectional associations of known correlates of cognition with cognitive scores, and assessed model fit before and after addition of LASSO-selected immune markers. RESULTS Among 1179 participants (mean age 70 ± 8.9 years, 60% women, 68% Hispanic), inclusion of LASSO-selected immune markers improved model fit above age, education, and other risk factors (p for likelihood ratio test < 0.005 for all domains). C-C Motif Chemokine Ligand 11 (CCL 11, eotaxin), C-X-C Motif Chemokine Ligand 9 (CXCL9), hepatocyte growth factor (HGF), and serpin E1 (plasminogen activator inhibitor-1) were associated with each of the domains and with overall cognitive function. Immune marker effects were comparable to conventional risk factors: for executive function, each standard deviation (SD) increase in CCL11 was associated with an effect equivalent to aging three years; for memory, HGF had twice the effect of aging. CONCLUSIONS Immune markers associate with cognitive function in a multi-ethnic cohort. Further work is needed to validate these findings and determine optimal treatment targets.
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Affiliation(s)
- Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Michelle Moon
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Ken Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mady Hornig
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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13
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Jiang J, Gao Y, Zhang R, Wang L, Zhao X, Dai Q, Zhang W, Xu X, Chen X. Differential Effects of Serum Lipoprotein-Associated Phospholipase A2 on Periventricular and Deep Subcortical White Matter Hyperintensity in Brain. Front Neurol 2021; 12:605372. [PMID: 33763010 PMCID: PMC7982574 DOI: 10.3389/fneur.2021.605372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose: Serum level of lipoprotein-associated phospholipase A2 (Lp-PLA2) was associated with white matter hyperintensity (WMH). There were differences in the anatomical structure and pathophysiological mechanism between periventricular WMH (PVWMH) and deep subcortical WMH (DSWMH). In this study, we aimed to investigate the effects of serum Lp-PLA2 on the PVWMH and DSWMH. Methods: In total, 711 Chinese adults aged ≥45 years with cranial magnetic resonance imaging (MRI) were recruited in this cross-sectional study, who had received physical examinations in the Department of Neurology, the Affiliated Jiangning Hospital of Nanjing Medical University due to dizziness and headaches between January 2016 and July 2019. Enzyme linked immunosorbent assay (ELISA) was utilized to determine the serum Lp-PLA2. Fazekas scale was used to measure the severity of PVWMH (grade 0-3) and DSWMH (grade 0-3) on MRI scans. Ordinal regression analysis was carried out to investigate the relationship between serum Lp-PLA2 and PVWMH or DSWMH. Results: Finally, 567 cases were included in this study. The average level of serum Lp-PLA2 was 213.35±59.34 ng/ml. There were statistical differences in the age, hypertension, diabetes mellitus, atrial fibrillation, lacunar infarction, Lp-PLA2 grade, creatinine, Hcy, and H-CRP (P < 0.05) in PVWMH groups. Ordinal regression analysis indicated that there was a lower risk of PVWMH in the patients with normal and moderately elevated serum Lp-PLA2 compared with those with significantly elevated serum Lp-PLA2 after adjusting age, hypertension, diabetes mellitus, atrial fibrillation, lacunar infarction, Cr, Hcy, and H-CRP. In addition, PVWMH was correlated to advanced age, hypertension, diabetes mellitus, and lacunar infarction. After adjusting for confounding factors, DSWMH was correlated to advanced age and lacunar infarction. There was no correlation between serum Lp-PLA2 and DSWMH. Conclusions: Serum Lp-PLA2 was closely associated with the pathogenesis of PVWMH rather than DSWMH. There might be different pathological mechanisms between PVWMH and DSWMH.
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Affiliation(s)
- Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Yuanyuan Gao
- Department of General Practice, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Xiaoyuan Zhao
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Xiujian Xu
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
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14
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Chen D, Peng S, Chen D, Yang F, Liu J, Wang J, Liu Q, Huang X, Ouyang P, Wang K, Li Z, Geng Y. Low lethal doses of Streptococcus iniae caused enteritis in Siberian sturgeon (Acipenser baerii). FISH & SHELLFISH IMMUNOLOGY 2020; 104:654-662. [PMID: 32561456 DOI: 10.1016/j.fsi.2020.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
In aquaculture, the incidence of enteritis due to Streptococcus iniae infection in Siberian sturgeon (Acipenser baerii) has increased in recent years. The pathogenesis of S. iniae is largely unknown due to the paucity of experimental studies on fish intestinal inflammation. In this study, S. iniae infection of A. baerii juveniles was induced by anal intubation of 0.15 mL at a low lethal dose (2 × 107 CFU/mL). Intestinal pathology and gene expression studies were conducted within 10 days of the experiment. Histopathological examination showed severe intestinal lesions, inflammatory cell infiltration, intestinal submucosa edema, epithelial cell shedding and necrosis. Predominant symptoms of exudative inflammation, metamorphic inflammation and proliferative inflammation on days 1-3, 4-6, and 7-10 post infection were shown, respectively. Ultrastructural observations also revealed fractured microvilli and shedding on days 4-6. Intestinal villi gradually repaired during the subsequent 7-10 days post infection. Expression of the pro-inflammatory cytokines, tumor necrosis factor and interleukin 1β were up-regulated on days 1-3 followed by a significant decrease on day 5, ultimately reaching control levels on day 10 post infection. A similar pattern was shown in mucus cells, involving mucin secretion and expression of the mucin encoding gene, Mucin-2. These results showed the cellular response to S. iniae infection associated with inflammatory genes expression in the Siberian sturgeon.
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Affiliation(s)
- Defang Chen
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Shuang Peng
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Daiyu Chen
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Fei Yang
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Jiaxi Liu
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Jun Wang
- Key Laboratory of Sichuan Province for Fishes Conservation and Utilization in the Upper Reaches of the Yangtze River, Neijiang Normal University, Neijiang, Sichuan, PR China
| | - Qiwei Liu
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Xiaoli Huang
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Ping Ouyang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Kaiyu Wang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Zhiqiong Li
- College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, PR China
| | - Yi Geng
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, PR China.
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15
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Wang M, Feng H, Zhang S, Luo Z, Liang Y, Xu Y, Mei B, Kong Z, Liu Y. Association between red blood cell distribution width and white matter hyperintensities: A large-scale cross-sectional study. Brain Behav 2020; 10:e01739. [PMID: 32683781 PMCID: PMC7503097 DOI: 10.1002/brb3.1739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/07/2020] [Accepted: 06/06/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) is a strong prognostic marker for various medical conditions, such as ischemic strokes. However, the relationships between higher RDW and the subtypes of white matter hyperintensities (WMHs) remain unclear. Hence, this study aimed to thoroughly evaluate the relationships between RDW and the subtypes of WMHs. PATIENTS AND METHODS This cross-sectional study was a retrospective analysis of hospital database (Dongguan Medical System, from April 2015 to February 2017). The presence and subtypes of WMHs were evaluated using Fazekas score with the T2WI-FLAIR brain images from a 1.5-T MRI system. The overall sample was randomly split in half. One of the two split-half samples was used for determining the optimal cutoff value of higher RDW and another for further statistical analyses. RESULTS A total of 555 subjects with WMHs and 642 controls were recruited. The optimal cutoff value of higher RDW was 13.25%. Logistic regression revealed that higher RDW (≥13.25%) was positively associated with periventricular WMHs (adjusted OR = 1.81, 95% CI: 1.16-2.82, p = .009). However, higher RDW was not associated with total WMHs (adjusted OR = 1.52, 95% CI: 0.99-2.33, p = .057) and deep WMHs (adjusted OR = 1.21, 95% CI: 0.76-1.94, p = .426). CONCLUSION Our findings suggested that higher RDW may be independently associated with periventricular WMHs, but not with total WMHs and deep WMHs.
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Affiliation(s)
- Meiyao Wang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Ultrasonography, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hongliang Feng
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., China
| | - Shuaimei Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhengjin Luo
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan Liang
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yan Xu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhaohong Kong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yumin Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
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16
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Yolk sac-derived Pdcd11-positive cells modulate zebrafish microglia differentiation through the NF-κB-Tgfβ1 pathway. Cell Death Differ 2020; 28:170-183. [PMID: 32709934 PMCID: PMC7853042 DOI: 10.1038/s41418-020-0591-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022] Open
Abstract
Microglia are the primary immune cells in the central nervous system, which plays a vital role in neuron development and neurodegenerative diseases. Microglial precursors in peripheral hematopoietic tissues colonize the central nervous system during early embryogenesis. However, how intrinsic and extrinsic signals integrate to regulate microglia’s differentiation remains undefined. In this study, we identified the cerebral white matter hyperintensities susceptibility gene, programmed cell death protein 11 (PDCD11), as an essential factor regulating microglia differentiation. In zebrafish, pdcd11 deficiency prevents the differentiation of the precursors to mature brain microglia. Although, the inflammatory featured macrophage brain colonization is augmented. At 22 h post fertilization, the Pdcd11-positive cells on the yolk sac are distinct from macrophages and neutrophils. Mechanistically, PDCD11 exerts its physiological role by differentially regulating the functions of nuclear factor-kappa B family members, P65 and c-Rel, suppressing P65-mediated expression of inflammatory cytokines, such as tnfα, and enhancing the c-Rel-dependent appearance of tgfβ1. The present study provides novel insights in understanding microglia differentiation during zebrafish development.
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17
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Gong X, Shan W, Yuan K, Lu Z, Zhang M, Lu J, Zhang X, Huang X, Guo H, Peng M, Liu X, Zhao X, Xu G. Dietary Inflammatory Index and Leukoaraiosis in Patients with Ischemic Stroke. J Nutr Health Aging 2020; 24:473-477. [PMID: 32346684 DOI: 10.1007/s12603-020-1351-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Diet may change the chronic levels of systemic inflammation, which in turn influence the development of leukoaraiosis (LA). This study aimed to examine the association between dietary inflammatory index (DII) and LA in patients with ischemic stroke. METHODS Patients with first-ever ischemic stroke were enrolled from two centers. A semi-quantitative food frequency questionnaire (FFQ) was used to evaluate diet contents. The DII score of each patient was calculated based on the reported diet contents. Presence and degree of LA were evaluated with a magnetic resonance imaging (MRI) scan. LA was graded according to Fazekas scale. RESULTS Of the 497 enrolled patients, 337 (67.8%) were detected with LA. Patients with LA had a higher DII score (0.23 vs -0.88, P < 0.001). Logistic regression analysis detected that patients with highest quartile of DII score had an OR of 3.61 (95% CI: 2.05-6.36, P < 0.001) for LA compared with those with lowest quartile of DII. After adjusting for major confounders, the highest DII quartile remained as an independent predictor for LA (OR = 2.66, 95% CI: 1.41-5.00, P = 0.008). CONCLUSIONS A pro-inflammatory diet pattern, as indicated by higher DII values, appears to be associated with a higher risk of LA. This result suggested that dietary-mediated inflammation may involved in the pathogenesis of LA, which warrant further study.
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Affiliation(s)
- X Gong
- Gelin Xu, Department of Neurology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. Tel: (+) 86- 18951919349; E-Mail: ; Xiongfei Zhao, Department of Neurology, Cardiovascular and Cerebrovascular Disease Hospital of Meishan, Meishan 620000, Sichuan, China. Tel: (+) 86-13609147368;
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18
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Al-Janabi OM, Brown CA, Bahrani AA, Abner EL, Barber JM, Gold BT, Goldstein LB, Murphy RR, Nelson PT, Johnson NF, Shaw LM, Smith CD, Trojanowski JQ, Wilcock DM, Jicha GA. Distinct White Matter Changes Associated with Cerebrospinal Fluid Amyloid-β1-42 and Hypertension. J Alzheimers Dis 2019; 66:1095-1104. [PMID: 30400099 DOI: 10.3233/jad-180663] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) pathology and hypertension (HTN) are risk factors for development of white matter (WM) alterations and might be independently associated with these alterations in older adults. OBJECTIVE To evaluate the independent and synergistic effects of HTN and AD pathology on WM alterations. METHODS Clinical measures of cerebrovascular disease risk were collected from 62 participants in University of Kentucky Alzheimer's Disease Center studies who also had cerebrospinal fluid (CSF) sampling and MRI brain scans. CSF Aβ1-42 levels were measured as a marker of AD, and fluid-attenuated inversion recovery imaging and diffusion tensor imaging were obtained to assess WM macro- and microstructural properties. Linear regression analyses were used to assess the relationships among WM alterations, cerebrovascular disease risk, and AD pathology. Voxelwise analyses were performed to examine spatial patterns of WM alteration associated with each pathology. RESULTS HTN and CSF Aβ1-42 levels were each associated with white matter hyperintensities (WMH). Also, CSF Aβ1-42 levels were associated with alterations in normal appearing white matter fractional anisotropy (NAWM-FA), whereas HTN was marginally associated with alterations in NAWM-FA. Linear regression analyses demonstrated significant main effects of HTN and CSF Aβ1-42 on WMH volume, but no significant HTN×CSF Aβ1-42 interaction. Furthermore, voxelwise analyses showed unique patterns of WM alteration associated with hypertension and CSF Aβ1-42. CONCLUSION Associations of HTN and lower CSF Aβ1-42 with WM alteration were statistically and spatially distinct, suggesting independent rather than synergistic effects. Considering such spatial distributions may improve diagnostic accuracy to address each underlying pathology.
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Affiliation(s)
- Omar M Al-Janabi
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Behavioral Science, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Christopher A Brown
- Departments of Neuroscience, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Ahmed A Bahrani
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Biomedical Engineering, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Epidemiology and Biostatistics, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Justin M Barber
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Brian T Gold
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Neuroscience, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Larry B Goldstein
- Departments of Neurology, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Ronan R Murphy
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Neurology, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Pathology, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Nathan F Johnson
- Departments of Rehabilitation Science, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Leslie M Shaw
- Department of Pathology & Laboratory Medicine, Institute on Aging, Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Charles D Smith
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Neurology, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - John Q Trojanowski
- Department of Pathology & Laboratory Medicine, Institute on Aging, Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Donna M Wilcock
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Physiology, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
| | - Gregory A Jicha
- Sanders-Brown Center on Aging, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Behavioral Science, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA.,Departments of Neurology, University of Kentucky Colleges of Medicine, Public Health, Health Sciences and Engineering Lexington, KY, USA
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Abstract
Objective: To study red cell distribution width (RDW), RDW to platelet ratio (RPR) and mean platelet volume to platelet ratio (MPR), novel inflammatory markers of routine hemogram, of patients with or without dementia, according to the grade of the disease established by Fazekas's score in magnetic resonance imaging (MRI). Methods: A total of 1342 cases that undergone cranial MRI study were retrospectively analyzed. Patients without a previous stroke and over 45 years were enrolled in the study. Demographic and laboratory characteristics of the participants were obtained from institutional computerized database. Subcortical and periventricular white matter were evaluated in axial FLAIR images according to Fazekas's grading scale. Univariate and multivariate analysis were performed for assessing the predictors of Fazekas's grading scale. Results: MPR of Fazekas 0, Fazekas 1, Fazekas 2 and Fazekas 3 groups were 3, 3, 4 and 3%, respectively. MPR difference between study groups was not significant (p = .32). RPR of Fazekas 0, Fazekas 1, Fazekas 2 and Fazekas 3 groups were 6, 7, 7 and 7%, respectively. RPR difference between study groups was significant (p < .001). Conclusion: We suggest that increased RDW and RPR values may indicate higher Fazekas's score and dementia in cranial imaging studies. The radiologist should pay particular attention in interpretation of cranial MRI of these patients.
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Affiliation(s)
- Emine Dagistan
- a Department of Radiology , Abant Izzet Baysal University , Bolu , Turkey
| | - Zeliha Cosgun
- a Department of Radiology , Abant Izzet Baysal University , Bolu , Turkey
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20
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Low A, Mak E, Rowe JB, Markus HS, O'Brien JT. Inflammation and cerebral small vessel disease: A systematic review. Ageing Res Rev 2019; 53:100916. [PMID: 31181331 DOI: 10.1016/j.arr.2019.100916] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/23/2019] [Accepted: 06/05/2019] [Indexed: 12/13/2022]
Abstract
Inflammation is increasingly implicated as a risk factor for dementia, stroke, and small vessel disease (SVD). However, the underlying mechanisms and causative pathways remain unclear. We systematically reviewed the existing literature on the associations between markers of inflammation and SVD (i.e., white matter hyperintensities (WMH), lacunes, enlarged perivascular spaces (EPVS), cerebral microbleeds (CMB)) in cohorts of older people with good health, cerebrovascular disease, or cognitive impairment. Based on distinctions made in the literature, markers of inflammation were classified as systemic inflammation (e.g. C-reactive protein, interleukin-6, fibrinogen) or vascular inflammation/endothelial dysfunction (e.g. homocysteine, von Willebrand factor, Lp-PLA2). Evidence from 82 articles revealed relatively robust associations between SVD and markers of vascular inflammation, especially amongst stroke patients, suggesting that alterations to the endothelium and blood-brain barrier may be a driving force behind SVD. Conversely, cross-sectional findings on systemic inflammation were mixed, although longitudinal investigations demonstrated that elevated levels of systemic inflammatory markers at baseline predicted subsequent SVD severity and progression. Importantly, regional analysis revealed that systemic and vascular inflammation were differentially related to two distinct forms of SVD. Specifically, markers of vascular inflammation tended to be associated with SVD in areas typical of hypertensive arteriopathy (e.g., basal ganglia), while systemic inflammation appeared to be involved in CAA-related vascular damage (e.g., centrum semiovale). Nonetheless, there is insufficient data to establish whether inflammation is causal of, or secondary to, SVD. Findings have important implications on interventions, suggesting the potential utility of treatments targeting the brain endothelium and blood brain barrier to combat SVD and associated neurodegenerative diseases.
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Affiliation(s)
- Audrey Low
- Department of Psychiatry, University of Cambridge, United Kingdom
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, United Kingdom
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, United Kingdom.
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21
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Huang WQ, Ye HM, Cai LL, Ma QL, Lu CX, Tong SJ, Tzeng CM, Lin Q. The Associations of PMF1, ICAM1, AGT, TRIM65, FBF1, and ACOX1 Variants With Leukoaraiosis in Chinese Population. Front Genet 2019; 10:615. [PMID: 31396257 PMCID: PMC6664056 DOI: 10.3389/fgene.2019.00615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 06/13/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Leukoaraiosis (LA) is shown as white matter hyperintensities on T2-weighted magnetic resonance imaging brain scans. Together with candidate gene association studies (CGAS), multiple genome-wide association studies (GWAS) have reported large numbers of single nucleotide polymorphisms (SNPs) to be associated with LA in European populations. To date, no replication studies have been reported in independent Chinese samples. Methods: Here, we performed a candidate gene association study comprising 220 Chinese subjects with LA and 50 controls. Thirty-nine polymorphisms on 32 risk genes were selected from previous studies, and they were genotyped through matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Genetic association analysis was firstly performed in all subjects with LA. Then, the same analysis was conducted in the six random sampling cohorts of 50 LA patients, respectively. Data analyses on the associations of SNPs with LA risk were evaluated through Pearson’s χ2 and multivariate logistic regression tests. Results: We found that eight polymorphisms in six genes (PMF1, ICAM1, TRIM65, AGT, FBF1, and ACOX1) were significantly associated with LA in the genetic association tests. Except for those eight gene variants, 24 other polymorphisms were not found to be significantly associated with LA in general genetic model, dominant model, recessive model, or multiplicative model. Among those eight polymorphisms, rs2984613 in PMF1 showed significant association with LA in the cohort of 220 LA subjects, and such significant association remained in both general genetic model (OR: 0.262, 95% CI: 0.091–0.752, padj = 0.030) and recessive model (OR: 0.323, 95% CI: 0.119–0.881, padj = 0.038) when controlling for clinical variables. Seven other significant variants (rs5498 in ICAM1, rs699 in AGT, rs2305913 in FBF1, rs1135640 in ACOX1, and rs3760128, rs7214628, and rs7222757 in TRIM65) were identified in those six random sampling tests that were conducted in the adjusted cohorts of 50 LA patients. In addition, except for rs699 which showed detrimental effect and represented a risk variant for LA, seven other polymorphisms seemed to exert protective effects on LA and to reduce the risk of LA. It is necessary to confirm these associations in an independent cohort. Conclusions: This first replication study on multiple genes in an independent Chinese population did not replicate any risk polymorphisms for LA other than rs 699 in AGT but revealed the significantly negative associations of PMF1, ICAM1, TRIM65, FBF1, and ACOX1 polymorphisms with LA. It not only supported the strong ethnic differences in the genetics of LA but also indicated that those six identified genes may be involved in Chinese white matter lesions. Larger scales of CGAS and GWAS are necessary to confirm and decipher those ethnic-Han specific risk genes for LA in China.
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Affiliation(s)
- Wen-Qing Huang
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Sciences, Xiamen University, Xiamen, China.,Shanghai Institute of Precision Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui-Ming Ye
- Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Liang-Liang Cai
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Sciences, Xiamen University, Xiamen, China
| | - Qi-Lin Ma
- Department of Neurology and Center for Brain Research, The First Affiliated Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Cong-Xia Lu
- Department of Neurology and Center for Brain Research, The First Affiliated Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Sui-Jun Tong
- Department of Neurology and Center for Brain Research, The First Affiliated Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center (TMRC), School of Pharmaceutical Sciences, Xiamen University, Xiamen, China.,College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Qing Lin
- Department of Neurology and Center for Brain Research, The First Affiliated Hospital of Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China.,Department of Neurology, The First Clinical Medical College and Graduate School of Fujian Medical University, Fuzhou, China
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22
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Brown RB, Traylor M, Burgess S, Sawcer S, Markus HS. Do Cerebral Small Vessel Disease and Multiple Sclerosis Share Common Mechanisms of White Matter Injury? Stroke 2019; 50:1968-1972. [PMID: 31221055 PMCID: PMC6661245 DOI: 10.1161/strokeaha.118.023649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The role of inflammation in ischemic white matter disease is increasingly recognized, and further understanding of the pathophysiology might inform future treatment strategies. Multiple sclerosis (MS) is a chronic autoimmune condition in which inflammation plays a central role that also affects the white matter. We hypothesized that white matter injury might share common mechanisms and used statistical genetics techniques to assess whether having genetically elevated white matter hyperintensity (WMH) volume was associated with increased MS risk. Methods— We investigated the genetic association in 2 cohorts with magnetic resonance imaging-quantified ischemic white matter lesion volume (WMH in stroke; n=2797 and UK Biobank; n=8353) and 14 802 cases of MS and 26 703 controls from the International Multiple Sclerosis Genetics Consortium. We further performed individual-level polygenic risk score calculations for MS and measures of structural white matter disease in UK Biobank. Finally, we looked for evidence of overlapping risk across the whole genome. Results— There was no association of genetic variants influencing MS with WMH volume using summary statistics in the WMH in stroke cohort (relative risk score =1.014; 95% CI, 0.936–1.110) or in the UK Biobank cohort (relative risk score =1.030; 95% CI, 0.932–1.117). Conversely, assessing the contribution of single nucleotide polymorphisms significantly associated with WMH on the risk of MS there was no significant association (relative risk score =0.930; 95% CI, 0.736–1.191). There were no significant associations between polygenic risk scores calculations; these results were robust to the selection of single nucleotide polymorphisms at a range of significance thresholds. Whole genome analysis did not reveal any overlap of risk between the traits. Conclusions— Our results do not provide evidence to suggest a shared mechanism of white matter damage in ischemia and MS. We propose that inflammation acts in distinct pathways because of the differing nature of the primary insult.
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Affiliation(s)
- Robin B Brown
- From the Department of Clinical Neurosciences (R.B.B., M.T., S.S., H.S.M.), University of Cambridge, United Kingdom
| | - Matthew Traylor
- From the Department of Clinical Neurosciences (R.B.B., M.T., S.S., H.S.M.), University of Cambridge, United Kingdom
| | - Stephen Burgess
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (S.B.), University of Cambridge, United Kingdom.,MRC Biostatistics Unit, Cambridge Institute of Public Health, United Kingdom (S.B.)
| | - Stephen Sawcer
- From the Department of Clinical Neurosciences (R.B.B., M.T., S.S., H.S.M.), University of Cambridge, United Kingdom
| | - Hugh S Markus
- From the Department of Clinical Neurosciences (R.B.B., M.T., S.S., H.S.M.), University of Cambridge, United Kingdom
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23
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Dhamoon MS, Cheung YK, Moon YP, Wright CB, Sacco RL, Elkind MSV. Interleukin-6 and lipoprotein-associated phospholipase A2 are associated with functional trajectories. PLoS One 2019; 14:e0214784. [PMID: 30934019 PMCID: PMC6443177 DOI: 10.1371/journal.pone.0214784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/20/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES Inflammatory biomarkers have been associated with stroke and mortality, but inflammation may also have detrimental effects beyond acute events. We hypothesized that serum concentrations of interleukin-6 (IL6) and lipoprotein-associated phospholipase A2 (LpPLA2) were inversely associated with long-term functional decline independently of vascular risk factors, stroke and myocardial infarction (MI) occurring during follow-up. DESIGN Prospective population based cohort study. SETTING The Northern Manhattan Study. PARTICIPANTS (INCLUDING THE SAMPLE SIZE) Race/ethnically diverse stroke-free individuals in northern Manhattan aged ≥40 years (n = 3298). INTERVENTION None. MEASUREMENTS Annual functional assessments with the Barthel index (BI), for a median of 13 years. BI was analyzed as a continuous variable (range 0-100). Baseline demographics, risk factors, and laboratory studies were collected, including IL6 (n = 1679), LpPLA2 mass (n = 1912) and activity (n = 1937). Separate mixed models estimated standardized associations between each biomarker and baseline functional status and change over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. RESULTS Mean age was 69 (SD 10) years, 35% were male, 53% Hispanic, 74% hypertensive, and 16-24% diabetic. LogIL6 was associated with decline in BI over time (-0.13 points per year, 95% CI -0.24, -0.02) and marginally with baseline BI (-0.20, 95% CI -0.40, 0.01). LpPLA2 activity levels were associated with baseline BI (-0.36, 95% CI -0.68, -0.04) but not change over time, and LpPLA2 mass levels were not associated with either. CONCLUSION In this large population-based study, higher serum inflammatory biomarker levels were associated with disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up.
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Affiliation(s)
- Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ying-Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Yeseon P. Moon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Clinton B. Wright
- National Institutes of Health, Bethesda, MD, United States of America
| | - Ralph L. Sacco
- McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Departments of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Mitchell S. V. Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
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24
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Ndrepepa G. Myeloperoxidase - A bridge linking inflammation and oxidative stress with cardiovascular disease. Clin Chim Acta 2019; 493:36-51. [PMID: 30797769 DOI: 10.1016/j.cca.2019.02.022] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 12/17/2022]
Abstract
Myeloperoxidase (MPO) is a member of the superfamily of heme peroxidases that is mainly expressed in neutrophils and monocytes. MPO-derived reactive species play a key role in neutrophil antimicrobial activity and human defense against various pathogens primarily by participating in phagocytosis. Elevated MPO levels in circulation are associated with inflammation and increased oxidative stress. Multiple lines of evidence suggest an association between MPO and cardiovascular disease (CVD) including coronary artery disease, congestive heart failure, arterial hypertension, pulmonary arterial hypertension, peripheral arterial disease, myocardial ischemia/reperfusion-related injury, stroke, cardiac arrhythmia and venous thrombosis. Elevated MPO levels are associated with a poor prognosis including increased risk for overall and CVD-related mortality. Elevated MPO may signify an increased risk for CVD for at least 2 reasons. First, low-grade inflammation and increased oxidative stress coexist with many metabolic abnormalities and comorbidities and consequently an elevated MPO level may represent an increased cardiometabolic risk in general. Second, MPO produces a large number of highly reactive species which can attack, destroy or modify the function of every known cellular component. The most common MPO actions relevant to CVD are generation of dysfunctional lipoproteins with an increased atherogenicity potential, reduced NO availability, endothelial dysfunction, impaired vasoreactivity and atherosclerotic plaque instability. These actions strongly suggest that MPO is directly involved in the pathophysiology of CVD. In this regard MPO may be seen as a mediator or an instrument through which inflammation promotes CVD at molecular and cellular level. Clinical value of MPO therapeutic inhibition remains to be tested.
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Affiliation(s)
- Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Lazarettstrasse 36, 80636 Munich, Germany.
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25
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Gu Y, Gutierrez J, Meier IB, Guzman VA, Manly JJ, Schupf N, Brickman AM, Mayeux R. Circulating inflammatory biomarkers are related to cerebrovascular disease in older adults. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 6:e521. [PMID: 30568999 PMCID: PMC6278856 DOI: 10.1212/nxi.0000000000000521] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/12/2018] [Indexed: 12/17/2022]
Abstract
Objective This investigation aimed at examining whether circulating inflammatory biomarkers C-reactive protein (CRP), interleukin-6 (IL6), and alpha 1-antichymotrypsin (ACT) were related to cerebrovascular disease (CVD) assessed by MRI. Methods The study included nondemented elderly participants of a community-based, multiethnic cohort, who received baseline MRI scans and had CRP (n = 508), ACT (435), and IL6 (N = 357) measured by ELISA. Silent brain infarcts and white matter hyperintensities (WMH) were derived from all available MRI scans at baseline, approximately 4.4 years after blood sample collection for inflammatory biomarkers. Repeated assessments of infarcts and WMH, as well as microbleeds assessment, were performed at follow-up MRI visits around 4.5 years later. Cross-sectional and longitudinal relationship between inflammatory biomarkers and CVD were analyzed using appropriate logistic regression models, generalized linear models, or COX models. Results After adjusting for age, sex, ethnicity, education, APOE genotype, and intracranial volume, 1 SD increase in log10IL6 was associated with infarcts on MRI {odds ratio [OR] (95% confidence interval [CI]) = 1.28 [1.02–1.60], p = 0.033}, and 1 SD increase in log10CRP and log10ACT was associated with microbleeds (OR [95% CI] = 1.46 [1.02–2.09], p = 0.041; and 1.65 [1.11–2.46], p = 0.013; respectively). One SD increase in log10ACT was also associated with larger WMH at the follow-up MRI (b = 0.103, p = 0.012) and increased accumulation of WMH volume (b = 0.062, p = 0.041) during follow-up. The associations remained significant after additional adjustment of vascular risk factors and excluding participants with clinical stroke. Conclusions Among older adults, increased circulating inflammatory biomarkers were associated with the presence of infarcts and microbleeds, WMH burden, and progression of WMH.
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Affiliation(s)
- Yian Gu
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Jose Gutierrez
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Irene B Meier
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Vanessa A Guzman
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Jennifer J Manly
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Nicole Schupf
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Adam M Brickman
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
| | - Richard Mayeux
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Y.G., I.B.M., V.A.G., J.J.M., N.S., A.M.B., R.M.), Columbia University; Department of Neurology (Y.G., J.G., J.J.M., N.S., A.M.B., R.M.), Columbia University and the New York Presbyterian Hospital; Department of Epidemiology (Y.G., N.S., R.M.), Joseph P. Mailman School of Public Health, Columbia University; and the Gertrude H. Sergievsky Center (Y.G., J.J.M., A.M.B., R.M.), Columbia University, New York
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Electrocardiographic left atrial abnormality and silent vascular brain injury: The Northern Manhattan Study. PLoS One 2018; 13:e0203774. [PMID: 30312297 PMCID: PMC6193576 DOI: 10.1371/journal.pone.0203774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/27/2018] [Indexed: 12/17/2022] Open
Abstract
Hypothesis We hypothesized that P wave terminal Force in the V1 lead (PTFV1) would be associated with leukoaraiosis and subclinical infarcts, especially cortical infarcts, in a population-based, multi-ethnic cohort. Methods PTFV1 was collected manually from baseline electrocardiograms of clinically stroke-free Northern Manhattan Study participants. Investigators read brain MRIs for superficial infarcts, deep infarcts, and white matter hyperintensity volume (WMHV). WMHV was adjusted for head size and log transformed, achieving a normal distribution. Logistic regression models investigated the association of PTFV1 with cortical and with all subclinical infarcts. Linear regression models examined logWMHV. Models were adjusted for demographics and risk factors. Results Among 1174 participants with PTFV1 measurements, the mean age at MRI was 70 ± 9 years. Participants were 14.4% white, 17.6% black, and 65.8% Hispanic. Mean PTFV1 was 3587.35 ± 2315.62 μV-ms. Of the 170 subclinical infarcts, 40 were cortical. PTFV1 ≥ 5000 μV-ms was associated with WMHV in a fully adjusted model (mean difference in logWMHV 0.15, 95% confidence interval 0.01–0.28). PTFV1 exhibited a trend toward an association with cortical infarcts (unadjusted OR per SD change logPTFV1 1.30, 95% CI 0.94–1.81), but not with all subclinical infarcts. Conclusion Electrocardiographic evidence of left atrial abnormality was associated with leukoaraiosis.
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Ao DH, Zhai FF, Han F, Zhou LX, Ni J, Yao M, Zhang DD, Li ML, Fan XH, Jin ZY, Cui LY, Zhang SY, Zhu YC. Large Vessel Disease Modifies the Relationship Between Kidney Injury and Cerebral Small Vessel Disease. Front Neurol 2018; 9:498. [PMID: 29997570 PMCID: PMC6028610 DOI: 10.3389/fneur.2018.00498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Recent studies have shown that renal disease is associated with magnetic resonance imaging (MRI) markers of cerebral small vessel disease (CSVD), independent of traditional vascular risk factors. Although large artery lesions might be involved in the cerebrorenal association, evidence has been lacking. Methods: A total of 928 participants from a population-based cohort study were included. Kidney injury measurements included urinary albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). CSVD was assessed on MRI by white matter hyperintensity volume (WMHV), lacunes, brain parenchymal fraction (BPF), cerebral microbleeds (CMBs), and perivascular space. Carotid plaques and brachial-ankle pulse wave velocity (baPWV) were used to assess large artery atherosclerosis and stiffness. Multivariable linear and logistic regression and additional interaction models were used for statistical analysis. Results: Individuals with elevated ACR had higher prevalence of lacunes and more WMHV (p = 0.001 and 0.000, respectively), those with decreased eGFR had smaller brain volume, higher prevalence of lacunes and deep CMBs (p = 0.009, p = 0.017) and p = 0.010 respectively). Interaction analysis revealed that carotid plaque and baPWV significantly enhanced the association between eGFR and BPF (p = 0.001 and p = 0.002, respectively), that is, the association of eGFR with BPF was only significant among participants with carotid plaque and higher baPWV. In addition, carotid plaque enhanced the association between ACR and WMHV (p = 0.034) and baPWV enhanced the association between ACR and the presence of lacunes (p = 0.027). Modifying effect of large vessel disease markers on the association between kidney injury measurements and CMBs was not significant. Conclusion: Evaluation of subclinical CVSD in individuals with kidney injury is warranted, especially in those with combined large artery disease.
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Affiliation(s)
- Dong-Hui Ao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei-Fei Zhai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ding-Ding Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Hong Fan
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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28
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Della-Morte D, Dong C, Markert MS, Elkind MSV, Sacco RL, Wright CB, Rundek T. Carotid Intima-Media Thickness Is Associated With White Matter Hyperintensities: The Northern Manhattan Study. Stroke 2017; 49:304-311. [PMID: 29284725 DOI: 10.1161/strokeaha.117.018943] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/20/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Brain white matter hyperintensities (WMH) have been associated with increased risk of stroke, cognitive decline, and dementia. WMH can be a manifestation of small vessel disease, although the total microvascular contribution to multifactorial WMH pathophysiology remains unknown. We hypothesized a possible relationship between carotid intima-media thickness (cIMT), an ultrasound imaging marker of subclinical vascular disease, and brain WMH in a multiethnic, elderly stroke-free community-based cohort. METHODS We evaluated the relationship between cIMT and WMH in the population-based Northern Manhattan Study, among individuals free of stroke. We used linear regression to examine the association of continuous measures of cIMT with quantitatively derived WMH volume, as a proportion of cranial volume, measured from fluid-attenuaded inversion recovery magnetic resonance imaging while adjusting for sociodemographics, lifestyle, and vascular risk factors. RESULTS In a cohort of 1229 participants (mean age, 71±9 years; 60% women, 15% White; 18% Black; 65% Hispanics), the mean cIMT was 0.71±0.08 mm and the median log-transformed WMH volume was 0.36 (interquartile range, 0.21-0.76). In a multivariable model, larger cIMT was significantly associated with greater WMH volume (β=0.046 per SD cIMT; P=0.04). Age and race/ethnicity were significant modifiers (P for age, 0.02; and P for race/ethnicity, 0.04). cIMT was associated with WMH volume in participants 70 years or older (β=0.088 per SD cIMT; P=0.01) and among Hispanics (β=0.084 per SD cIMT; P=0.003). CONCLUSIONS Larger cIMT was associated with greater burden of cerebral WM lesions independently of demographics and traditional vascular risk factors, particularly among elderly and Hispanic participants, who are at high risk for stroke and cognitive decline.
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Affiliation(s)
- David Della-Morte
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Chuanhui Dong
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Matthew S Markert
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Tatjana Rundek
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.).
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Yu G, Liang Y, Zheng S, Zhang H. Inhibition of Myeloperoxidase by N-Acetyl Lysyltyrosylcysteine Amide Reduces Oxidative Stress–Mediated Inflammation, Neuronal Damage, and Neural Stem Cell Injury in a Murine Model of Stroke. J Pharmacol Exp Ther 2017; 364:311-322. [DOI: 10.1124/jpet.117.245688] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/07/2017] [Indexed: 12/19/2022] Open
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30
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Phuah CL, Dave T, Malik R, Raffeld MR, Ayres AM, Goldstein JN, Viswanathan A, Greenberg SM, Jagiella JM, Hansen BM, Norrving B, Jimenez-Conde J, Roquer J, Pichler A, Enzinger C, Montaner J, Fernandez-Cadenas I, Lindgren A, Slowik A, Schmidt R, Biffi A, Rost N, Langefeld CD, Markus HS, Mitchell BD, Worrall BB, Kittner SJ, Woo D, Dichgans M, Rosand J, Anderson CD. Genetic variants influencing elevated myeloperoxidase levels increase risk of stroke. Brain 2017; 140:2663-2672. [PMID: 28969386 DOI: 10.1093/brain/awx220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022] Open
Abstract
Primary intracerebral haemorrhage and lacunar ischaemic stroke are acute manifestations of progressive cerebral microvascular disease. Current paradigms suggest atherosclerosis is a chronic, dynamic, inflammatory condition precipitated in response to endothelial injury from various environmental challenges. Myeloperoxidase plays a central role in initiation and progression of vascular inflammation, but prior studies linking myeloperoxidase with stroke risk have been inconclusive. We hypothesized that genetic determinants of myeloperoxidase levels influence the development of vascular instability, leading to increased primary intracerebral haemorrhage and lacunar stroke risk. We used a discovery cohort of 1409 primary intracerebral haemorrhage cases and 1624 controls from three studies, an extension cohort of 12 577 ischaemic stroke cases and 25 643 controls from NINDS-SiGN, and a validation cohort of 10 307 ischaemic stroke cases and 29 326 controls from METASTROKE Consortium with genome-wide genotyping to test this hypothesis. A genetic risk score reflecting elevated myeloperoxidase levels was constructed from 15 common single nucleotide polymorphisms identified from prior genome-wide studies of circulating myeloperoxidase levels (P < 5 × 10-6). This genetic risk score was used as the independent variable in multivariable regression models for association with primary intracerebral haemorrhage and ischaemic stroke subtypes. We used fixed effects meta-analyses to pool estimates across studies. We also used Cox regression models in a prospective cohort of 174 primary intracerebral haemorrhage survivors for association with intracerebral haemorrhage recurrence. We present effects of myeloperoxidase elevating single nucleotide polymorphisms on stroke risk per risk allele, corresponding to a one allele increase in the myeloperoxidase increasing genetic risk score. Genetic determinants of elevated circulating myeloperoxidase levels were associated with both primary intracerebral haemorrhage risk (odds ratio, 1.07, P = 0.04) and recurrent intracerebral haemorrhage risk (hazards ratio, 1.45, P = 0.006). In analysis of ischaemic stroke subtypes, the myeloperoxidase increasing genetic risk score was strongly associated with lacunar subtype only (odds ratio, 1.05, P = 0.0012). These results, demonstrating that common genetic variants that increase myeloperoxidase levels increase risk of primary intracerebral haemorrhage and lacunar stroke, directly implicate the myeloperoxidase pathway in the pathogenesis of cerebral small vessel disease. Because genetic variants are not influenced by environmental exposures, these results provide new support for a causal rather than bystander role for myeloperoxidase in the progression of cerebrovascular disease. Furthermore, these results support a rationale for chronic inflammation as a potential modifiable stroke risk mechanism, and suggest that immune-targeted therapies could be useful for treatment and prevention of cerebrovascular disease.
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Affiliation(s)
- Chia-Ling Phuah
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA, USA
| | - Tushar Dave
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Rainer Malik
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Miriam R Raffeld
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Alison M Ayres
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | | | - Anand Viswanathan
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Jeremiasz M Jagiella
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Björn M Hansen
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Jordi Jimenez-Conde
- Neurovascular Research Unit, Department of Neurology, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Roquer
- Neurovascular Research Unit, Department of Neurology, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Austria.,Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Joan Montaner
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital, Terrassa, Spain
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Alessandro Biffi
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA.,Division of Behavioral Neurology, Department of Neurology, MGH, Boston, MA, USA.,Division of Neuropsychiatry, Department of Psychiatry, MGH, Boston, MA, USA
| | - Natalia Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Carl D Langefeld
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Braxton D Mitchell
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Brad B Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA.,Department of Public Health Science, University of Virginia, Charlottesville, VA, USA
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Neurology, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) and Munich Cluster for Systems Neurology (SyNergy), Germany
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Christopher D Anderson
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
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31
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Wright CB, Dong C, Perez EJ, De Rosa J, Yoshita M, Rundek T, DeCarli C, Gutierrez J, Elkind MSV, Sacco RL. Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study. J Am Heart Assoc 2017; 6:JAHA.116.004069. [PMID: 28847914 PMCID: PMC5634244 DOI: 10.1161/jaha.116.004069] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. METHODS AND RESULTS Stroke-free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non-Hispanic white, 17% non-Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6-9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1-1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0-1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1-4.4). White and black but not Hispanic participants had increased stroke risk (P<0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1-3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3-3.8), lacunar (HR: 4.0; 95% CI, 1.3-12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0-12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1-1.7) and nonvascular (HR: 1.2; 95% CI, 1.0-1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4-5.8). CONCLUSIONS In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.
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Affiliation(s)
- Clinton B Wright
- Evelyn F. McKnight Brain Institute, Leonard M. Miller School of Medicine, University of Miami, FL .,Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Neuroscience Program, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Chuanhui Dong
- Evelyn F. McKnight Brain Institute, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Enmanuel J Perez
- Evelyn F. McKnight Brain Institute, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Neuroscience Program, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Janet De Rosa
- Department of Neurology, College of Physicians and Surgeons, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Mitsuhiro Yoshita
- National Hospital Organization, Hokuriku National Hospital, Nanto, Japan
| | - Tatjana Rundek
- Evelyn F. McKnight Brain Institute, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Human Genomics, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Charles DeCarli
- Department of Neurology, University of California at Davis Health System, Sacramento, CA
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Ralph L Sacco
- Evelyn F. McKnight Brain Institute, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, FL.,Department of Human Genomics, Leonard M. Miller School of Medicine, University of Miami, FL
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32
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Rundek T, Della-Morte D, Gardener H, Dong C, Markert MS, Gutierrez J, Roberts E, Elkind MSV, DeCarli C, Sacco RL, Wright CB. Relationship between carotid arterial properties and cerebral white matter hyperintensities. Neurology 2017; 88:2036-2042. [PMID: 28446647 DOI: 10.1212/wnl.0000000000003951] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/28/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Since arterial stiffness is a functional measure of arterial compliance and may be an important marker of cerebrovascular disease, we examined the association of carotid artery stiffness with white matter hyperintensity volume (WMHV) in a cross-sectional study of 1,166 stroke-free participants. METHODS Carotid beta stiffness index (STIFF) was assessed by M-mode ultrasound of the common carotid artery and calculated as the ratio of natural log of the difference between systolic and diastolic blood pressure over STRAIN, a ratio of the difference between carotid systolic and diastolic diameter (DD) divided by DD. WMHV was measured by fluid-attenuated inversion recovery MRI. The associations of STIFF, DD, and STRAIN with WMHV were examined using linear regression after adjusting for sociodemographic, lifestyle, and vascular risk factors. RESULTS In a fully adjusted model, larger carotid DD was significantly associated with greater log-WMHV (β = 0.09, p = 0.001). STIFF and STRAIN were not significantly associated with WMHV. In adjusted analyses stratified by race-ethnicity, STRAIN (β = -1.78, p = 0.002) and DD (β = 0.11, p = 0.001) were both associated with greater log-WMHV among Hispanic participants, but not among black or white participants. CONCLUSIONS Large carotid artery diameters are associated with greater burden of white matter hyperintensity (WMH) in this multiethnic population. The association between increased diameters, decreased STRAIN, and greater WMH burden is more pronounced among Hispanics. These associations suggest a potential important pathophysiologic role of extracranial large artery remodeling in the burden of WMH.
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Affiliation(s)
- Tatjana Rundek
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - David Della-Morte
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis.
| | - Hannah Gardener
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Chuanhui Dong
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Matthew S Markert
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Jose Gutierrez
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Eugene Roberts
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Mitchell S V Elkind
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Charles DeCarli
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Ralph L Sacco
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Clinton B Wright
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
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Katan M, Moon Y, von Eckardstein A, Spanaus K, DeRosa J, Gutierrez J, DeCarli C, Wright C, Sacco R, Elkind M. Procalcitonin and Midregional Proatrial Natriuretic Peptide as Biomarkers of Subclinical Cerebrovascular Damage: The Northern Manhattan Study. Stroke 2017; 48:604-610. [PMID: 28123058 DOI: 10.1161/strokeaha.116.014945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/25/2016] [Accepted: 11/18/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Chronic infections and cardiac dysfunction are risk factors for stroke. We hypothesized that blood biomarkers of infection (procalcitonin) and cardiac dysfunction (midregional proatrial natriuretic peptide [MR-proANP]), previously associated with small vessel stroke and cardioembolic stroke are also associated with subclinical cerebrovascular damage, including silent brain infarcts and white matter hyperintensity volume. METHODS The NOMAS (Northern Manhattan Study) was designed to assess risk factors for incident vascular disease in a multiethnic cohort. A subsample underwent brain magnetic resonance imaging and had blood samples available for biomarker measurement (n=1178). We used logistic regression models to estimate the odds ratios and 95% confidence intervals (95% CIs) for the association of these biomarkers with silent brain infarcts after adjusting for demographic, behavioral, and medical risk factors. We used linear regression to assess associations with log-white matter hyperintensity volume. RESULTS Mean age was 70±9 years; 60% were women, 66% Hispanic, 17% black, and 15% were white. After adjusting for risk factors, subjects with procalcitonin or MR-proANP in the top quartile, compared with the lowest quartile were more likely to have silent brain infarcts (adjusted odds ratio for procalcitonin, 2.2; 95% CI, 1.3-3.7 and for MR-proANP, 3.3; 95% CI, 1.7-6.3) and increased white matter hyperintensity volume (adjusted mean change in log-white matter hyperintensity volume for procalcitonin, 0.29; 95% CI, 0.13-0.44 and for MR-proANP, 0.18; 95% CI, 0.004-0.36). CONCLUSIONS Higher concentrations of procalcitonin, a marker of infection, and MR-proANP, a marker of cardiac dysfunction, are independently associated with subclinical cerebrovascular damage. If further studies demonstrate an incremental value for risk stratification, biomarker-guided primary prevention studies may lead to new approaches to prevent cerebrovascular disease.
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Affiliation(s)
- Mira Katan
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL.
| | - Yeseon Moon
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Arnold von Eckardstein
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Kathartina Spanaus
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Janet DeRosa
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Jose Gutierrez
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Charles DeCarli
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Clinton Wright
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Ralph Sacco
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
| | - Mitchell Elkind
- From the Departments of Neurology (M.K., Y.M., J.D.R., J.G., M.E.) and Epidemiology (M.E.), Columbia University, New York, NY; Departments of Neurology (M.K.) and Clinical Chemistry (A.v.E., K.S.), University Hospital of Zurich, Switzerland; Department of Neurology, University of California at Davis, Sacramento (C.D.C.); and Departments of Neurology (C.W., R.S.), Public Health Sciences (R.S.), and Human Genetics (R.S.), University of Miami, FL
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Dhamoon MS, Cheung YK, Moon YP, Wright CB, Willey JZ, Sacco R, Elkind MS. C-reactive protein is associated with disability independently of vascular events: the Northern Manhattan Study. Age Ageing 2017; 46:77-83. [PMID: 28181636 DOI: 10.1093/ageing/afw179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background High-sensitivity C-reactive protein (CRP) has been associated with cardiovascular events and mortality, but the association of CRP with functional status is not well defined. We hypothesised that serum levels of high-sensitivity CRP are associated with long-term trajectories of functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up. Design Prospective, population-based. Setting Northern Manhattan Study. Participants Stroke-free participants aged ≥40 years. Measurements Annual assessments of disability with the Barthel index (BI) for a median of 13 years. BI was analysed as a continuous variable (range 0–100). Baseline demographics, risk factors and laboratory studies were collected, including CRP (n = 2,240). Separate generalised estimating equation models estimated standardised associations between CRP and (i) baseline functional status and (ii) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. Results Mean age was 69 (SD 10) years, 36% were male, 55% Hispanic, 75% hypertensive and 21% diabetic; 337 MIs and 369 first strokes occurred during follow-up. Mean CRP level was 5.24 mg/l (SD 8.86). logCRP was associated with baseline BI (−0.34 BI points per unit logCRP, 95% confidence interval −0.62, −0.06) but not with change over time. Conclusions In this large population-based study, higher serum CRP levels were associated with higher baseline disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Systemic inflammation may contribute to disability independently of clinical vascular events.
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Affiliation(s)
- Mandip S Dhamoon
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | | | - Yeseon P Moon
- Biostatistics, Columbia University, New York, NY, USA
| | | | | | - Ralph Sacco
- Medicine, University of Miami, Miami, FL, USA
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Nadkarni NK, Boudreau RM, Studenski SA, Lopez OL, Liu G, Kritchevsky S, Yaffe K, Newman AB, Rosano C. Slow gait, white matter characteristics, and prior 10-year interleukin-6 levels in older adults. Neurology 2016; 87:1993-1999. [PMID: 27733566 DOI: 10.1212/wnl.0000000000003304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the relationship between gait speed and prior 10 years interleukin-6 (IL-6) burden in older adults. We then assessed whether white matter characteristics influence this relationship. METHODS In 179 community-dwelling older adults, gait speed was assessed on an automated walkway and serum IL-6 was assayed on ELISA. Concurrently, white matter characteristics were assessed on MRI by quantifying volume of white matter hyperintensities (WMH), a marker of small vessel disease, and normal-appearing white matter on fractional anisotropy (NAWM-FA), a marker of axonal integrity. IL-6 was assayed at regular intervals at gait assessment and over the prior 10 years and estimates of sustained 10-year IL-6 exposure and the rate of change in IL-6 over 10 years were obtained. Multivariate linear regressions were used to examine the relationships among sustained IL-6 exposure, rate of change in IL-6, gait speed, and white matter characteristics. RESULTS In this sample (age 83 years, 58% female, 41% black, gait speed 0.9 m/s), higher sustained IL-6 levels, but not the rate of change in IL-6 or IL-6 at gait assessment, was significantly related to slower gait (β = -0.27, p < 0.001) and to higher WMH (β = 0.23, p = 0.002), but not NAWM-FA, withstanding covariate adjustments. WMH accounted for 30% attenuation in the relationship between higher sustained IL-6 levels and slower gait speed (p = 0.043) in the mediation analyses. CONCLUSIONS Sustained exposure to high IL-6 over 10 years rather than the rate of change in IL-6 or an isolated high IL-6 level may adversely affect gait speed by influencing cerebral WMH.
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Affiliation(s)
- Neelesh K Nadkarni
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD.
| | - Robert M Boudreau
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Stephanie A Studenski
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Oscar L Lopez
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Ge Liu
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Stephen Kritchevsky
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Kristine Yaffe
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Anne B Newman
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
| | - Caterina Rosano
- From the Division of Geriatric Medicine and Gerontology, Department of Medicine (N.K.N.), Department of Neurology (O.L.L.) and the Pittsburgh Alzheimer's Disease Research Center (O.L.L., N.K.N.), University of Pittsburgh School of Medicine, and Department of Epidemiology, Graduate School of Public Health (R.M.B., G.L., A.B.N., C.R.), University of Pittsburgh, PA; Sticht Center on Aging (S.K.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Psychiatry (K.Y.), University of California at San Francisco; and the Longitudinal Studies Section (S.A.S.), Translational Gerontology Branch, National Institute on Aging, Baltimore, MD
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Esenwa CC, Elkind MS. Inflammatory risk factors, biomarkers and associated therapy in ischaemic stroke. Nat Rev Neurol 2016; 12:594-604. [DOI: 10.1038/nrneurol.2016.125] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Umemura T, Kawamura T, Hotta N. Pathogenesis and neuroimaging of cerebral large and small vessel disease in type 2 diabetes: A possible link between cerebral and retinal microvascular abnormalities. J Diabetes Investig 2016; 8:134-148. [PMID: 27239779 PMCID: PMC5334292 DOI: 10.1111/jdi.12545] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/23/2016] [Indexed: 01/14/2023] Open
Abstract
Diabetes patients have more than double the risk of ischemic stroke compared with non‐diabetic individuals, and its neuroimaging characteristics have important clinical implications. To understand the pathophysiology of ischemic stroke in diabetes, it is important to focus not only on the stroke subtype, but also on the size and location of the occlusive vessels. Specifically, ischemic stroke in diabetes patients might be attributed to both large and small vessels, and intracranial internal carotid artery disease and small infarcts of the posterior circulation often occur. An additional feature is that asymptomatic lacunar infarctions are often seen in the basal ganglia and brain stem on brain magnetic resonance imaging. In particular, cerebral small vessel disease (SVD), including lacunar infarctions, white matter lesions and cerebral microbleeds, has been shown to be associated not only with stroke incidence, but also with the development and progression of dementia and diabetic microangiopathy. However, the pathogenesis of cerebral SVD is not fully understood. In addition, data on the association between neuroimaging findings of the cerebral SVD and diabetes are limited. Recently, the clinical importance of the link between cerebral SVD and retinal microvascular abnormalities has been a topic of considerable interest. Several clinical studies have shown that retinal microvascular abnormalities are closely related to cerebral SVD, suggesting that retinal microvascular abnormalities might be pathophysiologically linked to ischemic cerebral SVD. We review the literature relating to the pathophysiology and neuroimaging of cerebrovascular disease in diabetes, and discuss the problems based on the concept of cerebral large and small vessel disease.
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Affiliation(s)
| | - Takahiko Kawamura
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.,Department of Preventive Medical Center, Chubu Rosai Hospital, Nagoya, Japan
| | - Nigishi Hotta
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan
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Yu G, Liang Y, Huang Z, Jones DW, Pritchard KA, Zhang H. Inhibition of myeloperoxidase oxidant production by N-acetyl lysyltyrosylcysteine amide reduces brain damage in a murine model of stroke. J Neuroinflammation 2016; 13:119. [PMID: 27220420 PMCID: PMC4879722 DOI: 10.1186/s12974-016-0583-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/13/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Oxidative stress plays an important and causal role in the mechanisms by which ischemia/reperfusion (I/R) injury increases brain damage after stroke. Accordingly, reducing oxidative stress has been proposed as a therapeutic strategy for limiting damage in the brain after stroke. Myeloperoxidase (MPO) is a highly potent oxidative enzyme that is capable of inducing both oxidative and nitrosative stress in vivo. METHODS To determine if and the extent to which MPO-generated oxidants contribute to brain I/R injury, we treated mice subjected to middle cerebral artery occlusion (MCAO) with N-acetyl lysyltyrosylcysteine amide (KYC), a novel, specific and non-toxic inhibitor of MPO. Behavioral testing, ischemic damage, blood-brain-barrier disruption, apoptosis, neutrophils infiltration, microglia/macrophage activation, and MPO oxidation were analyzed within a 7-day period after MCAO. RESULTS Our studies show that KYC treatment significantly reduces neurological severity scores, infarct size, IgG extravasation, neutrophil infiltration, loss of neurons, apoptosis, and microglia/macrophage activation in the brains of MCAO mice. Immunofluorescence studies show that KYC treatment reduces the formation of chlorotyrosine (ClTyr), a fingerprint biomarker of MPO oxidation, nitrotyrosine (NO2Tyr), and 4-hydroxynonenal (4HNE) in MCAO mice. All oxidative products colocalized with MPO in the infarcted brains, suggesting that MPO-generated oxidants are involved in forming the oxidative products. CONCLUSIONS MPO-generated oxidants play detrimental roles in causing brain damage after stroke which is effectively reduced by KYC.
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Affiliation(s)
- Guoliang Yu
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Ye Liang
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Ziming Huang
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.,Department of Breast Surgery, Maternal and Child Health Hospital of Hubei Province, 745 WuLuo Road, Hongshan District, Wuhan City, Hubei Province, 430070, China
| | - Deron W Jones
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Kirkwood A Pritchard
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Hao Zhang
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
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Red Blood Cell Distribution Width Is Associated with Severity of Leukoaraiosis. PLoS One 2016; 11:e0150308. [PMID: 26918441 PMCID: PMC4769290 DOI: 10.1371/journal.pone.0150308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/11/2016] [Indexed: 01/13/2023] Open
Abstract
Red blood cell distribution width (RDW) is one of the routine hematologic parameters reported in the complete blood count test, which has been recognized as strong prognostic marker for various medical conditions, especially cardiovascular disease. We evaluated that RDW was also associated with the leukoaraiosis; common radiological finding of brain and that has been strongly associated with risk of stroke and dementia. In the present study, we included 1006 non-stroke individuals who underwent brain MRI and routine complete blood count test including RDW. Fazekas scale was used to measure the severity of leukoaraiosis based on fluid-attenuated inversion recovery image, and the severity was dichotomized to mild-degree (Fazekas scale: 0–1) and severe-degree leukoaraiosis (Fazekas scale: 2–3). Univariate and multivariate logistic regression models were constructed to evaluate independent risk factor for severe-degree of leukoaraiosis. Mean age of 1006 subjects was 64.34 ± 9.11 year, and mean of RDW was 12.97 ± 0.86%. The severe-degree of leukoaraiosis (Fazekas scale ≥ 2) was found in 28.83%. In the multivariate logistic regression, 4th quartile of RDW (> 13.3%) were significantly associated with the presence of severe-degree of leukoaraiosis (adjusted odds ratio, 1.87; 95% confidence interval, 1.20–2.92) compared to the 1st quartile of RDW (< 12.5%). The significance was not changed after adjustments for hemoglobin and other hematologic indices. These findings suggest that RDW is independently associated with severity of leukoaraiosis.
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Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability. J Cereb Blood Flow Metab 2016; 36:55-71. [PMID: 25899297 PMCID: PMC4758557 DOI: 10.1038/jcbfm.2015.68] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 12/26/2022]
Abstract
Vascular dementia is the second most common type of dementia after Alzheimer’s disease (AD). Subcortical ischemic vascular disease refers to a form of vascular cognitive impairment characterized by the presence of diffuse white matter hyperintensities (WMHs) and multiple lacunar infarcts. These neuroimaging findings are mainly caused by cerebral small-vessel disease (cSVD) and relate to aging and cognitive impairment, but they can also be silent and highly prevalent in otherwise healthy individuals. We aimed to review studies on blood and cerebrospinal fluid (CSF) markers related to the presence of WMHs and lacunar infarcts that have been conducted in the past in large population-based studies and in high-risk selected patients (such as those with vascular risk factors, vascular cognitive impairment, or AD). Relevant associations with the presence and progression of cSVD have been described in the blood for markers related to inflammatory processes, endothelial damage and coagulation/fibrinolysis processes, etc. Also, different combinations of CSF markers might help to differentiate between etiologic types of dementia. In the future, to translate these findings into clinical practice and use biomarkers to early diagnosis and monitoring vascular cognitive impairment would require the replication of candidate markers in large-scale, multicenter, and prospectively designed studies.
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APOE ɛ2 is associated with white matter hyperintensity volume in CADASIL. J Cereb Blood Flow Metab 2016; 36:199-203. [PMID: 25920955 PMCID: PMC4758562 DOI: 10.1038/jcbfm.2015.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/20/2015] [Accepted: 04/03/2015] [Indexed: 12/21/2022]
Abstract
Apolipoprotein E (APOE) increases the risk for Alzheimer’s disease (ɛ4 allele) and cerebral amyloid angiopathy (ɛ2 and ɛ4), but its role in small vessel disease (SVD) is debated. Here we studied the effects of APOE on white matter hyperintensity volume (WMHV) in CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), a nonamyloidogenic angiopathy and inherited early-onset form of pure SVD. Four hundred and eighty-eight subjects were recruited through a multicenter consortium. Compared with APOE ɛ3/ɛ3, WMHV was increased in APOE ɛ2 (P = 0.02) but not APOE ɛ4. The results remained significant when controlled for genome-wide genetic background variation. Our findings suggest a modifying influence of APOE ɛ2 on WMHV caused by pure SVD.
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Poggesi A, Pasi M, Pescini F, Pantoni L, Inzitari D. Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: A review. J Cereb Blood Flow Metab 2016; 36:72-94. [PMID: 26058695 PMCID: PMC4758546 DOI: 10.1038/jcbfm.2015.116] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/17/2015] [Accepted: 05/05/2015] [Indexed: 01/04/2023]
Abstract
The term cerebral small vessel disease (SVD) refers to a group of pathologic processes with various etiologies that affect small arteries, arterioles, venules, and capillaries of the brain. Magnetic resonance imaging (MRI) correlates of SVD are lacunes, recent small subcortical infarcts, white-matter hyperintensities, enlarged perivascular spaces, microbleeds, and brain atrophy. Endothelial dysfunction is thought to have a role in the mechanisms leading to SVD-related brain changes, and the study of endothelial dysfunction has been proposed as an important step for a better comprehension of cerebral SVD. Among available methods to assess endothelial function in vivo, measurement of molecules of endothelial origin in peripheral blood is currently receiving selective attention. These molecules include products of endothelial cells that change when the endothelium is activated, as well as molecules that reflect endothelial damage and repair. This review examines the main molecular factors involved in both endothelial function and dysfunction, and the evidence linking endothelial dysfunction with cerebral SVD, and gives an overview of clinical studies that have investigated the possible association between endothelial circulating biomarkers and SVD-related brain changes.
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Affiliation(s)
- Anna Poggesi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Marco Pasi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Pantoni
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Domenico Inzitari
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
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Lin Q, Huang WQ, Tzeng CM. Genetic associations of leukoaraiosis indicate pathophysiological mechanisms in white matter lesions etiology. Rev Neurosci 2015; 26:343-58. [PMID: 25781674 DOI: 10.1515/revneuro-2014-0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/18/2014] [Indexed: 11/15/2022]
Abstract
Leukoaraiosis (LA), also called white matter lesions (WMLs) and white matter hyperintensities (WMHs), is a frequent neuroimaging finding commonly seen on magnetic resonance imaging brain scans of elderly people with prevalence ranging from 50% to 100%. Although it remains asymptomatic, LA is not considered to be benign, and it is showed to be related to a host of poor clinical outcomes and increases the risk of disability, dementia, depression, stroke, and the overall morbidity and mortality. Pathologically, LA is characterized by loss of myelin and axons, patchy demyelination, and denudation of ependyma in regions of WMH. Age and hypertension are the most importantly established risk factors for LA. However, the precise pathogenic mechanisms remain unclear. Together with the previous findings, our recent genetic results strongly supported that LA is associated with immune response and neuroinflammation. Therefore, we confidently hypothesized that LA was not only a common neuroimaging phenomenon in the elderly but also an emerging neuroinflammatory disorder in the central nervous system. This article focusing on neuroimaging classification, genetics basis, and putative molecular mechanism introduced the basic knowledge and current status of LA and put forward some of our research ideas and results from our molecular genetics research, which may pave the way for deciphering the putative pathogenic mechanism, risk factor, epigenetic index, and its application in diagnostic agents or drug target for prevention and treatment. Thus, it could provide clinicians and researchers with a specific and modern overview of LA to enable the understanding of recent progress and future directions in this illness.
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Arvanitakis Z, Fleischman DA, Arfanakis K, Leurgans SE, Barnes LL, Bennett DA. Association of white matter hyperintensities and gray matter volume with cognition in older individuals without cognitive impairment. Brain Struct Funct 2015; 221:2135-46. [PMID: 25833685 PMCID: PMC4592368 DOI: 10.1007/s00429-015-1034-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 03/19/2015] [Indexed: 01/18/2023]
Abstract
Both presence of white matter hyperintensities (WMH) and smaller total gray matter volume on brain magnetic resonance imaging (MRI) are common findings in old age, and contribute to impaired cognition. We tested whether total WMH volume and gray matter volume had independent associations with cognition in community-dwelling individuals without dementia or mild cognitive impairment (MCI). We used data from participants of the Rush Memory and Aging Project. Brain MRI was available in 209 subjects without dementia or MCI (mean age 80; education = 15 years; 74 % women). WMH and gray matter were automatically segmented, and the total WMH and gray matter volumes were measured. Both MRI-derived measures were normalized by the intracranial volume. Cognitive data included composite measures of five different cognitive domains, based on 19 individual tests. Linear regression analyses, adjusted for age, sex, and education, were used to examine the relationship of logarithmically-transformed total WMH volume and of total gray matter volume to cognition. Larger total WMH volumes were associated with lower levels of perceptual speed (p < 0.001), but not with episodic memory, semantic memory, working memory, or visuospatial abilities (all p > 0.10). Smaller total gray matter volumes were associated with lower levels of perceptual speed (p = 0.013) and episodic memory (p = 0.001), but not with the other three cognitive domains (all p > 0.14). Larger total WMH volume was correlated with smaller total gray matter volume (p < 0.001). In a model with both MRI-derived measures included, the relation of WMH to perceptual speed remained significant (p < 0.001), while gray matter volumes were no longer related (p = 0.14). This study of older community-dwelling individuals without overt cognitive impairment suggests that the association of larger total WMH volume with lower perceptual speed is independent of total gray matter volume. These results help elucidate the pathological processes leading to lower cognitive function in aging.
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Affiliation(s)
- Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Ave, Suite 1020, Chicago, IL, 60612, USA. .,Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Ave, Suite 1020, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Ave, Suite 1020, Chicago, IL, 60612, USA.,Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Rush University Medical Center, Chicago, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Ave, Suite 1020, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Ave, Suite 1020, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Ave, Suite 1020, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, USA
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Verhaaren BF, Debette S, Bis JC, Smith JA, Ikram MK, Adams HH, Beecham AH, Rajan KB, Lopez LM, Barral S, van Buchem MA, van der Grond J, Smith AV, Hegenscheid K, Aggarwal NT, de Andrade M, Atkinson EJ, Beekman M, Beiser AS, Blanton SH, Boerwinkle E, Brickman AM, Bryan RN, Chauhan G, Chen CP, Chouraki V, de Craen AJ, Crivello F, Deary IJ, Deelen J, De Jager PL, Dufouil C, Elkind MS, Evans DA, Freudenberger P, Gottesman RF, Guðnason V, Habes M, Heckbert SR, Heiss G, Hilal S, Hofer E, Hofman A, Ibrahim-Verbaas CA, Knopman DS, Lewis CE, Liao J, Liewald DC, Luciano M, van der Lugt A, Martinez OO, Mayeux R, Mazoyer B, Nalls M, Nauck M, Niessen WJ, Oostra BA, Psaty BM, Rice KM, Rotter JI, von Sarnowski B, Schmidt H, Schreiner PJ, Schuur M, Sidney SS, Sigurdsson S, Slagboom PE, Stott DJ, van Swieten JC, Teumer A, Töglhofer AM, Traylor M, Trompet S, Turner ST, Tzourio C, Uh HW, Uitterlinden AG, Vernooij MW, Wang JJ, Wong TY, Wardlaw JM, Windham BG, Wittfeld K, Wolf C, Wright CB, Yang Q, Zhao W, Zijdenbos A, Jukema JW, Sacco RL, Kardia SL, Amouyel P, Mosley TH, Longstreth WT, DeCarli CC, van Duijn CM, Schmidt R, Launer LJ, Grabe HJ, Seshadri SS, Ikram MA, Fornage M. Multiethnic genome-wide association study of cerebral white matter hyperintensities on MRI. CIRCULATION. CARDIOVASCULAR GENETICS 2015; 8:398-409. [PMID: 25663218 PMCID: PMC4427240 DOI: 10.1161/circgenetics.114.000858] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/23/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The burden of cerebral white matter hyperintensities (WMH) is associated with an increased risk of stroke, dementia, and death. WMH are highly heritable, but their genetic underpinnings are incompletely characterized. To identify novel genetic variants influencing WMH burden, we conducted a meta-analysis of multiethnic genome-wide association studies. METHODS AND RESULTS We included 21 079 middle-aged to elderly individuals from 29 population-based cohorts, who were free of dementia and stroke and were of European (n=17 936), African (n=1943), Hispanic (n=795), and Asian (n=405) descent. WMH burden was quantified on MRI either by a validated automated segmentation method or a validated visual grading scale. Genotype data in each study were imputed to the 1000 Genomes reference. Within each ethnic group, we investigated the relationship between each single-nucleotide polymorphism and WMH burden using a linear regression model adjusted for age, sex, intracranial volume, and principal components of ancestry. A meta-analysis was conducted for each ethnicity separately and for the combined sample. In the European descent samples, we confirmed a previously known locus on chr17q25 (P=2.7×10(-19)) and identified novel loci on chr10q24 (P=1.6×10(-9)) and chr2p21 (P=4.4×10(-8)). In the multiethnic meta-analysis, we identified 2 additional loci, on chr1q22 (P=2.0×10(-8)) and chr2p16 (P=1.5×10(-8)). The novel loci contained genes that have been implicated in Alzheimer disease (chr2p21 and chr10q24), intracerebral hemorrhage (chr1q22), neuroinflammatory diseases (chr2p21), and glioma (chr10q24 and chr2p16). CONCLUSIONS We identified 4 novel genetic loci that implicate inflammatory and glial proliferative pathways in the development of WMH in addition to previously proposed ischemic mechanisms.
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Affiliation(s)
- Benjamin F.J. Verhaaren
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Radiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Stéphanie Debette
- Inserm U897, Université Bordeaux Segalen, Bordeaux
- Dept of Neurology, Lariboisière Hospital, Paris
- Inserm U1191, Montpellier, France
- Dept of Neurology, Boston Univ School of Medicine, Boston, MA
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Dept of Medicine, Seattle, WA
| | - Jennifer A. Smith
- Dept of Epidemiology, School of Public Health, Univ of Michigan, Ann Arbor, MI
| | - M. Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, National Univ of Singapore & National Univ Health System, Singapore
- Dept of Ophthalmology, National Univ of Singapore & National Univ Health System, Singapore
- Memory Aging & Cognition Centre, National Univ of Singapore, Singapore
| | - Hieab H. Adams
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Radiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Ashley H. Beecham
- John P. Hussman Institute for Human Genomics, Univ of Miami, Miller School of Medicine, Miami, FL
| | | | - Lorna M. Lopez
- Centre for Cognitive Ageing & Cognitive Epidemiology, Psychology, Univ of Edinburgh, United Kingdom
| | - Sandra Barral
- Dept of Neurology, Columbia Univ Medical Ctr, New York, NY
| | | | | | | | - Katrin Hegenscheid
- Dept of Diagnostic Radiology & Neuroradiology, Univ Medicine Greifswald, Greifswald, Germany
| | | | - Mariza de Andrade
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN
| | | | - Marian Beekman
- Dept of Molecular Epidemiology, Leiden Univ Medical Ctr, Leiden, the Netherlands
| | - Alexa S. Beiser
- Dept of Neurology, Boston Univ School of Medicine, Boston, MA
- National Heart, Lung, & Blood Institute's Framingham Heart Study, Framingham
- Dept of Biostatistics, Boston Univ School of Public Health, Boston, MA
| | - Susan H. Blanton
- John P. Hussman Institute for Human Genomics, Univ of Miami, Miller School of Medicine, Miami, FL
- Dr. John T. Macdonald Foundation Dept of Human Genetics, Univ of Miami, Miller School of Medicine, Miami, FL
- Neuroscience Program, Univ of Miami, Miller School of Medicine, Miami, FL
| | - Eric Boerwinkle
- Human Genetics Ctr, Univ of Texas Health Science Ctr at Houston, Houston, TX
| | - Adam M. Brickman
- G.H. Sergievsky Ctr, Taub Institute for Research on Alzheimer’s Disease & Aging Brain, Columbia Univ Medical Ctr, New York, NY
| | - R. Nick Bryan
- Dept of Radiology, Perelman School of Medicine, Univ of Pennsylvania Health System, Philadelphia, PA
| | - Ganesh Chauhan
- Inserm U897, Université Bordeaux Segalen, Bordeaux
- Inserm U1191, Montpellier, France
| | | | - Vincent Chouraki
- Dept of Neurology, Boston Univ School of Medicine, Boston, MA
- National Heart, Lung, & Blood Institute's Framingham Heart Study, Framingham
| | - Anton J.M. de Craen
- Dept of Gerontology & Geriatrics, Leiden Univ Medical Ctr, Leiden, the Netherlands
| | | | - Ian J. Deary
- Centre for Cognitive Ageing & Cognitive Epidemiology, Psychology, Univ of Edinburgh, United Kingdom
| | - Joris Deelen
- Dept of Molecular Epidemiology, Leiden Univ Medical Ctr, Leiden, the Netherlands
| | | | | | - Mitchell S.V. Elkind
- Dept of Neurology, College of Physicians & Surgeons, Dept of Epidemiology, Mailman School of Public Health, Columbia Univ, New York, NY
| | | | - Paul Freudenberger
- Institute of Molecular Biology & Biochemistry, Medical Univ Graz, Graz, Austria
| | | | - Vilmundur Guðnason
- The Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, Univ of Iceland, Reykjavik, Iceland
| | - Mohamad Habes
- Dept of Radiology, Perelman School of Medicine, Univ of Pennsylvania Health System, Philadelphia, PA
- Institutes for Community Medicine, Univ Medicine Greifswald, Greifswald, Germany
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, Dept of Medicine, Seattle, WA
- Cardiovascular Health Research Unit, Dept of Medicine Epidemiology, Univ of Washington, Seattle, WA
| | - Gerardo Heiss
- Dept of Epidemiology, Univ of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC
| | - Saima Hilal
- Memory Aging & Cognition Centre, National Univ of Singapore, Singapore
| | - Edith Hofer
- Dept of Neurology, Clinical Division of Neurogeriatrics, Medical Univ Graz, Graz, Austria
- Institute for Medical Informatics, Statistics & Documentation, Medical Univ Graz, Graz, Austria
| | - Albert Hofman
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Carla A. Ibrahim-Verbaas
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Neurology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | | | - Cora E. Lewis
- Division of Preventive Medicine, Univ of Alabama, Birmingham, AL
| | - Jiemin Liao
- Singapore Eye Research Institute, Singapore National Eye Centre, National Univ of Singapore & National Univ Health System, Singapore
- Dept of Ophthalmology, National Univ of Singapore & National Univ Health System, Singapore
| | - David C.M. Liewald
- Centre for Cognitive Ageing & Cognitive Epidemiology, Psychology, Univ of Edinburgh, United Kingdom
| | - Michelle Luciano
- Centre for Cognitive Ageing & Cognitive Epidemiology, Psychology, Univ of Edinburgh, United Kingdom
| | - Aad van der Lugt
- Dept of Radiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Oliver O. Martinez
- Alzheimer's Disease Ctr, Imaging of Dementia & Aging (IdeA) Laboratory, Dept of Neurology, Ctr for Neuroscience, Univ of California, Davis, CA
| | - Richard Mayeux
- G.H. Sergievsky Ctr, Taub Institute for Research on Alzheimer’s Disease & Aging Brain, Columbia Univ Medical Ctr, New York, NY
| | | | - Mike Nalls
- Laboratory of Neurogenetics, The National Institutes of Health, Bethesda, MD
| | - Matthias Nauck
- Clinical Chemistry & Laboratory Medicine, Univ Medicine Greifswald, Greifswald, Germany
| | - Wiro J. Niessen
- Dept of Radiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Medical Informatics, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Faculty of Applied Sciences, Delft Univ of Technology, Delft, the Netherlands
| | - Ben A. Oostra
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Dept of Medicine, Seattle, WA
- Cardiovascular Health Research Unit, Dept of Medicine Epidemiology, Univ of Washington, Seattle, WA
- Cardiovascular Health Research Unit, Dept of Medicine Health Services, Univ of Washington, Seattle, WA
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Kenneth M. Rice
- Cardiovascular Health Research Unit, Dept of Biostatistics, Univ of Washington, Seattle, WA
| | - Jerome I. Rotter
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Ctr, Torrance, CA
- Dept of Neurology, Univ Medicine of Greifswald, Greifswald, Germany
| | | | - Helena Schmidt
- Dept of Neurology, Johns Hopkins Univ School of Medicine, Baltimore, MD
| | - Pamela J. Schreiner
- Division of Epidemiology & Community Health, Univ of Minnesota, Minneapolis, MN
| | - Maaike Schuur
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Neurology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | | | | | - P. Eline Slagboom
- Dept of Molecular Epidemiology, Leiden Univ Medical Ctr, Leiden, the Netherlands
| | - David J.M. Stott
- Institute of Cardiovascular and Medical Sciences, Faculty of Medicine, Univ of Glasgow, Glasgow
| | | | - Alexander Teumer
- Interfaculty Institute for Genetics & Functional Genomics, Univ Medicine Greifswald, Greifswald, Germany
| | | | - Matthew Traylor
- Research Centre for Stroke & Dementia, St. George's, Univ of London, London, United Kingdom
| | - Stella Trompet
- Dept of Cardiology, Leiden Univ Medical Ctr, Leiden, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | | | | | - Hae-Won Uh
- Dept of Medical Statistics & Bioinformatics, Leiden Univ Medical Ctr, Leiden, the Netherlands
| | - André G. Uitterlinden
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Internal Medicine, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Clinical Chemistry, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Meike W. Vernooij
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Radiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Jing J. Wang
- National Heart, Lung, & Blood Institute's Framingham Heart Study, Framingham
- Dept of Biostatistics, Boston Univ School of Public Health, Boston, MA
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National Univ of Singapore & National Univ Health System, Singapore
- Dept of Ophthalmology, National Univ of Singapore & National Univ Health System, Singapore
| | - Joanna M. Wardlaw
- Centre for Cognitive Ageing & Cognitive Epidemiology, Psychology, Univ of Edinburgh, United Kingdom
- Brain Research Imaging Centre, SINAPSE Collaboration, Centre for Clinical Brain Sciences, Univ of Edinburgh, United Kingdom
| | - B. Gwen Windham
- Division of Geriatrics/ Gerontology, Univ of Mississippi Medical Ctr, Jackson, MS
| | - Katharina Wittfeld
- German Ctr for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | | | - Clinton B. Wright
- Neuroscience Program, Univ of Miami, Miller School of Medicine, Miami, FL
- Dept of Epidemiology & Public Health Sciences, Univ of Miami, Miller School of Medicine, Miami, FL
- Dept of Neurology, Univ of Miami, Miller School of Medicine, Miami, FL
- Evelyn F. McKnight Brain Institute, Univ of Miami, Miller School of Medicine, Miami, FL
| | - Qiong Yang
- National Heart, Lung, & Blood Institute's Framingham Heart Study, Framingham
- Dept of Biostatistics, Boston Univ School of Public Health, Boston, MA
| | - Wei Zhao
- Dept of Epidemiology, School of Public Health, Univ of Michigan, Ann Arbor, MI
| | | | - J. Wouter Jukema
- Dept of Cardiology, Leiden Univ Medical Ctr, Leiden, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Ralph L. Sacco
- Dept of Epidemiology & Public Health Sciences, Univ of Miami, Miller School of Medicine, Miami, FL
- Dept of Neurology, Univ of Miami, Miller School of Medicine, Miami, FL
- Evelyn F. McKnight Brain Institute, Univ of Miami, Miller School of Medicine, Miami, FL
| | - Sharon L.R. Kardia
- Dept of Epidemiology, School of Public Health, Univ of Michigan, Ann Arbor, MI
| | - Philippe Amouyel
- Inserm, U744, Lille, France
- Université Lille 2, Lille, France
- Institut Pasteur de Lille, Lille, France
- Ctr Hospitalier Régional Universitaire de Lille, Lille, France
| | | | - W. T. Longstreth
- Cardiovascular Health Research Unit, Dept of Medicine Epidemiology, Univ of Washington, Seattle, WA
- Cardiovascular Health Research Unit, Dept of Neurology, Univ of Washington, Seattle, WA
| | - Charles C. DeCarli
- Alzheimer's Disease Ctr, Imaging of Dementia & Aging (IdeA) Laboratory, Dept of Neurology, Ctr for Neuroscience, Univ of California, Davis, CA
| | | | - Reinhold Schmidt
- Dept of Neurology, Clinical Division of Neurogeriatrics, Medical Univ Graz, Graz, Austria
| | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, & Biometry, National Institute of Aging, The National Institutes of Health, Bethesda, MD
| | - Hans J. Grabe
- Dept of Psychiatry & Psychotherapy, Univ Medicine Greifswald, Greifswald, Germany
| | - Sudha S. Seshadri
- Dept of Neurology, Boston Univ School of Medicine, Boston, MA
- National Heart, Lung, & Blood Institute's Framingham Heart Study, Framingham
| | - M. Arfan Ikram
- Dept of Epidemiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Radiology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
- Dept of Neurology, Erasmus MC Univ Medical Ctr, Rotterdam, the Netherlands
| | - Myriam Fornage
- Human Genetics Ctr, Univ of Texas Health Science Ctr at Houston, Houston, TX
- Institute of Molecular Medicine, Univ of Texas Health Science Ctr at Houston, Houston, TX
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Akoudad S, Sedaghat S, Hofman A, Koudstaal PJ, van der Lugt A, Ikram MA, Vernooij MW. Kidney function and cerebral small vessel disease in the general population. Int J Stroke 2015; 10:603-8. [PMID: 25753173 DOI: 10.1111/ijs.12465] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/24/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Anatomic and hemodynamic similarities between renal and cerebral vessels suggest a tight link between kidney disease and brain disease. Although several distinct markers are used to identify subclinical kidney and brain disease, a comprehensive assessment of how these markers link damage at both end organs is lacking. AIM To investigate whether measures of kidney function were associated with cerebral small vessel disease on MRI. METHODS In 2526 participants of the population-based Rotterdam Study, we measured urinary albumin-to-creatinine ratio, and estimated glomerular filtration rate based on serum creatinine and cystatin C. All participants underwent brain magnetic resonance imaging. We assessed presence of cerebral small vessel disease by calculating white matter lesion volumes and rating the presence of lacunes and cerebral microbleeds. We used multivariable linear and logistic regression to investigate the association between kidney function and cerebral small vessel disease. RESULTS Worse kidney function was consistently associated with a larger white matter lesion volume (mean difference per standard deviation increase in albumin-to-creatinine ratio: 0.09, 95% confidence interval 0.05; 0.12; per standard deviation decrease in creatinine-based estimated glomerular filtration rate: -0.04, 95% confidence interval -0.08;-0.01, and per standard deviation decrease in cystatin C-based estimated glomerular filtration rate: -0.09, 95% confidence interval -0.13;-0.05). Persons with higher albumin-to-creatinine ratio or lower cystatin C-based estimated glomerular filtration rate levels had a higher prevalence of lacunes (odds ratio per standard deviation increase in albumin-to-creatinine ratio: 1.24, 95% confidence interval 1.07; 1.43). Only participants in the highest quartile of albumin-to-creatinine ratio had a higher frequency of microbleeds compared to the lowest quartile. CONCLUSIONS Worse kidney function is associated with cerebral small vessel disease. Of all measures of kidney function, in particular albumin-to-creatinine ratio is related to cerebral small vessel disease.
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Affiliation(s)
- Saloua Akoudad
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanaz Sedaghat
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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47
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Windham BG, Simpson BN, Lirette S, Bridges J, Bielak L, Peyser PA, Kullo I, Turner S, Griswold ME, Mosley TH. Associations between inflammation and cognitive function in African Americans and European Americans. J Am Geriatr Soc 2015; 62:2303-10. [PMID: 25516026 DOI: 10.1111/jgs.13165] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine associations between specific inflammatory biomarkers and cognitive function in African Americans (AAs) and European Americans (EAs) with prevalent vascular risk factors. DESIGN Cross-sectional analysis using generalized estimating equations to account for familial clustering; standardized β-coefficients, adjusted for age, sex, and education are reported. SETTING Community cohort study in Jackson, Mississippi, and Rochester, Minnesota. PARTICIPANTS Genetic Epidemiology Network of Arteriopathy (GENOA)-Genetics of Microangiopathic Brain Injury (GMBI) Study participants. MEASUREMENTS Associations between inflammation (high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, soluble tumor necrosis factor (TNF) receptor 1 and 2 (sTNFR1, sTNFR2)) and cognitive function (global, processing speed, language, memory, and executive function) were examined in AAs and EAs (N = 1,965; aged 26-95, 64% women, 52% AA, 75% with hypertension). RESULTS In AAs, higher sTNFR2 was associated with poorer cognition in all domains (global: -0.11, P = .009; processing speed: -0.11, P < .001; language: -0.08, P = .002; memory: -0.09, P = .008; executive function: -0.07, P = .03); sTNFR1 was associated with slower processing speed (-0.08, P < .001) and poorer executive function (-0.08, P = .008); higher CRP was associated with slower processing speed (-0.04, P = .024), and higher IL6 was associated with poorer executive function (-0.07, P = .02). In EA, only higher sTNFR1 was associated with slower processing speed (-0.05, P = .007). Associations were not found between cognition and sTNFR2, CRP, or IL6 in EA. CONCLUSION In a population with high vascular risk, adverse associations between inflammation and cognitive function were especially apparent in AAs, primarily involving markers of TNFα activity.
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Affiliation(s)
- B Gwen Windham
- Division of Geriatric Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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48
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Shoamanesh A, Preis SR, Beiser AS, Vasan RS, Benjamin EJ, Kase CS, Wolf PA, DeCarli C, Romero JR, Seshadri S. Inflammatory biomarkers, cerebral microbleeds, and small vessel disease: Framingham Heart Study. Neurology 2015; 84:825-32. [PMID: 25632086 DOI: 10.1212/wnl.0000000000001279] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We investigated the association between circulating biomarkers of inflammation and MRI markers of small vessel disease. METHODS We performed a cross-sectional study relating a panel of 15 biomarkers, representing systemic inflammation (high-sensitivity C-reactive protein, interleukin-6, monocyte chemotactic protein-1, tumor necrosis factor α, tumor necrosis factor receptor 2, osteoprotegerin, and fibrinogen), vascular inflammation (intercellular adhesion molecule 1, CD40 ligand, P-selectin, lipoprotein-associated phospholipase A2 mass and activity, total homocysteine, and vascular endothelial growth factor), and oxidative stress (myeloperoxidase) to ischemic (white matter hyperintensities/silent cerebral infarcts) and hemorrhagic (cerebral microbleeds) markers of cerebral small vessel disease (CSVD) on MRI in 1,763 stroke-free Framingham offspring (mean age 60.2 ± 9.1 years, 53.7% women). RESULTS We observed higher levels of circulating tumor necrosis factor receptor 2 and myeloperoxidase in the presence of cerebral microbleed (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1-4.1 and OR 1.5, 95% CI 1.1-2.0, respectively), higher levels of osteoprotegerin (OR 1.1, 95% CI 1.0-1.2), intercellular adhesion molecule 1 (OR 1.7, 95% CI 1.1-2.5), and lipoprotein-associated phospholipase A2 mass (OR 1.5, 95% CI 1.1-2.1), and lower myeloperoxidase (OR 0.8, 95% CI 0.7-1.0) in participants with greater white matter hyperintensity volumes and silent cerebral infarcts. CONCLUSIONS Our study supports a possible role for inflammation in the pathogenesis of CSVD, but suggests that differing inflammatory pathways may underlie ischemic and hemorrhagic subtypes. If validated in other samples, these biomarkers may improve stroke risk prognostication and point to novel therapeutic targets to combat CSVD.
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Affiliation(s)
- Ashkan Shoamanesh
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento.
| | - Sarah R Preis
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Alexa S Beiser
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Ramachandran S Vasan
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Emelia J Benjamin
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Carlos S Kase
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Philip A Wolf
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Charles DeCarli
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Jose R Romero
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
| | - Sudha Seshadri
- From McMaster University (A.S.), Hamilton, Canada; Harvard Medical School (A.S.), Boston; Boston University School of Public Health (S.R.P., A.S.B.); Boston University School of Medicine (A.S.B., R.S.V., E.J.B., C.S.K., P.A.W., J.R.R., S.S.), MA; and University of California (C.D.), Davis School of Medicine, Sacramento
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Riba-Llena I, Penalba A, Pelegrí D, Vilar A, Jarca CI, Filomena J, Montaner J, Delgado P. Role of lipoprotein-associated phospholipase A2 activity for the prediction of silent brain infarcts in women. Atherosclerosis 2014; 237:811-5. [PMID: 25463126 DOI: 10.1016/j.atherosclerosis.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/15/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lipoprotein-associated phospholipase A2 (Lp-PLA2), predicts risk of coronary events and stroke and might be associated with cerebral small vessel disease. We aimed to determine whether silent brain infarcts relate to Lp-PLA2 activity and also, whether the addition of Lp-PLA2 activity to prognostic clinical models improves silent brain infarcts' discrimination. METHODS Cross-sectional study in 921 stroke-free individuals. On baseline, demographic and vascular risk factors were collected and a brain magnetic resonance was performed to assess for the presence of silent brain infarcts. Serum Lp-PLA2 activity was tested by an enzymatic assay (PLAC Test for activity) for all study participants and 49 healthy individuals free of vascular risk factors. Multivariate analysis and Integrated Discrimination Improvement were performed to assess whether Lp-PLA2 activity was independently associated with silent brain infarcts and improved their discrimination added to clinical variables. RESULTS Lp-PLA2 activity was independently associated with silent brain infarcts in women (OR per one standard deviation increase: 2.14, from 1.31 to 3.50) but not in men (OR = 1.09, from 0.81 to 1.48) after adjustment by age, diastolic blood pressure, total cholesterol, statin treatment and other potential confounders. Adding Lp-PLA2 to clinical information for SBIs diagnosis resulted in a non-significant and mild improvement in discrimination (IDI = 3.1%) in women. CONCLUSIONS Although Lp-PLA2 is independently associated with silent brain infarcts in women, its addition to clinical variables does not lead to any improvement in their prediction.
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Affiliation(s)
- Iolanda Riba-Llena
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Dolors Pelegrí
- Clinical Biochemistry Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Andrea Vilar
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Josefina Filomena
- Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Stroke Unit and Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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50
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Carmichael O. Preventing vascular effects on brain injury and cognition late in life: knowns and unknowns. Neuropsychol Rev 2014; 24:371-87. [PMID: 25085314 DOI: 10.1007/s11065-014-9264-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/23/2014] [Indexed: 12/14/2022]
Abstract
For some researchers, the relationship between prevalent cardiovascular risk factors and late-life cognitive decline is not worthy of further study. It is already known that effective treatment of vascular risk factors lowers risk of such major outcomes as stroke and heart attack, the argument goes; thus, any new information about the relationship between vascular risk factors and another major outcome--late-life cognitive decline--is unlikely to have an impact on clinical practice. The purpose of this review is to probe the logic of this argument by focusing on what is known, and what is not known, about the relationship between vascular risk factors and late-life cognitive decline. The unknowns are substantial: in particular, there is relatively little evidence that current vascular risk factor treatment protocols are adequate to prevent late-life cognitive decline or the clinically silent brain injury that precedes it. In addition, there is relatively little understanding of which factors lead to differential vulnerability or resilience to the effects of vascular risk factors on silent brain injury. Differential effects of different classes of treatments are similarly unclear. Finally, there is limited understanding of the impact of clinically-silent neurodegenerative disease processes on cerebrovascular processes. Further study of the relationships among vascular risk factors, brain injury, and late-life cognitive decline could have a major impact on development of new vascular therapies and on clinical management of vascular risk factors, and there are promising avenues for future research in this direction.
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Affiliation(s)
- Owen Carmichael
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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