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Bonney SK, Nielson CD, Sosa MJ, Bonnar O, Shih AY. Capillary regression leads to sustained local hypoperfusion by inducing constriction of upstream transitional vessels. Proc Natl Acad Sci U S A 2024; 121:e2321021121. [PMID: 39236241 DOI: 10.1073/pnas.2321021121] [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: 12/01/2023] [Accepted: 08/07/2024] [Indexed: 09/07/2024] Open
Abstract
In the brain, a microvascular sensory web coordinates oxygen delivery to regions of neuronal activity. This involves a dense network of capillaries that send conductive signals upstream to feeding arterioles to promote vasodilation and blood flow. Although this process is critical to the metabolic supply of healthy brain tissue, it may also be a point of vulnerability in disease. Deterioration of capillary networks is a feature of many neurological disorders and injuries and how this web is engaged during vascular damage remains unknown. We performed in vivo two-photon microscopy on young adult mural cell reporter mice and induced focal capillary injuries using precise two-photon laser irradiation of single capillaries. We found that ~59% of the injuries resulted in regression of the capillary segment 7 to 14 d following injury, and the remaining repaired to reestablish blood flow within 7 d. Injuries that resulted in capillary regression induced sustained vasoconstriction in the upstream arteriole-capillary transition (ACT) zone at least 21 days postinjury in both awake and anesthetized mice. The degree of vasomotor dynamics was chronically attenuated in the ACT zone consequently reducing blood flow in the ACT zone and in secondary, uninjured downstream capillaries. These findings demonstrate how focal capillary injury and regression can impair the microvascular sensory web and contribute to cerebral hypoperfusion.
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Affiliation(s)
- Stephanie K Bonney
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101
| | - Cara D Nielson
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101
- Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195
| | - Maria J Sosa
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101
| | - Orla Bonnar
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129
| | - Andy Y Shih
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101
- Department of Pediatrics, University of Washington, Seattle, WA 98195
- Department of Bioengineering, University of Washington, Seattle, WA 98195
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2
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Hori S, Okamoto S, Kubo M, Horie Y, Kuroda S. Cerebral microbleeds is a predictor of recurrent small vessel cerebrovascular disease: Evaluation based on the recurrent stroke pattern. J Stroke Cerebrovasc Dis 2024; 33:107812. [PMID: 38878842 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107812] [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: 03/28/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVES An increased number of cerebral microbleeds (CMBs) is considered a predictive factor for recurrent small vessel cerebrovascular diseases, including lacunar infarction and non-lobar intracerebral hemorrhage (ICH). However, it is unclear which recurrent stroke pattern is mainly reflected in the number of CMBs. MATERIALS AND METHODS This study enrolled 217 patients with their first stroke (148 deep lacunar infarctions and 69 non-lobar ICHs), between January 2009 and March 2015. The numbers of baseline and newly appearing CMBs in patients with recurrent stroke were compared with those in patients with non-recurrent stroke, and the dynamics of the number of CMBs was evaluated according to recurrent stroke patterns. RESULTS Fifty-nine patients with recurrent stroke were included in this study. A larger number of baseline and newly appearing CMBs was significantly associated with recurrent stroke (p = 0.04, p < 0.001, respectively). Recurrent stroke patterns were divided into four types: deep lacunar infarction/deep lacunar infarction (37 patients), deep lacunar infarction/non-lobar ICH (eight patients), non-lobar ICH/deep lacunar infarction (eight patients), and non-lobar ICH/non-lobar ICH (six patients). The number of newly appearing CMBs was significantly higher in patients with deep lacunar infarction/non-lobar ICH than in those with other recurrent stroke patterns (p = 0.04). CONCLUSIONS The number of CMBs is associated with recurrent stroke, including deep lacunar infarction and non-lobar ICH, and differs depending on the recurrent stroke patterns. The increase in the number of CMBs was strongly correlated with the deep lacunar infarction/non-lobar ICH recurrence pattern.
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Affiliation(s)
- Satoshi Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan; Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan.
| | - Soshi Okamoto
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Michiya Kubo
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Yukio Horie
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan.
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3
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Wang X, Lyu J, Duan Q, Li C, Huang J, Meng Z, Wu X, Chen W, Wang G, Niu Q, Li X, Bian Y, Han D, Guo W, Yang S, Bian X, Lan Y, Wang L, Zhang T, Duan C, Lou X. Deep medullary vein damage correlates with small vessel disease in small vessel occlusion acute ischemic stroke. Eur Radiol 2024; 34:6026-6035. [PMID: 38337069 PMCID: PMC11364723 DOI: 10.1007/s00330-024-10628-4] [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: 04/15/2023] [Revised: 10/20/2023] [Accepted: 11/11/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES We aim to investigate whether cerebral small vessel disease (cSVD) imaging markers correlate with deep medullary vein (DMV) damage in small vessel occlusion acute ischemic stroke (SVO-AIS) patients. METHODS The DMV was divided into six segments according to the regional anatomy. The total DMV score (0-18) was calculated based on segmental continuity and visibility. The damage of DMV was grouped according to the quartiles of the total DMV score. Neuroimaging biomarkers of cSVD including white matter hyperintensity (WMH), cerebral microbleed (CMB), perivascular space (PVS), and lacune were identified. The cSVD score were further analyzed. RESULTS We included 229 SVO-AIS patients, the mean age was 63.7 ± 23.1 years, the median NIHSS score was 3 (IQR, 2-6). In the severe DMV burden group (the 4th quartile), the NIHSS score grade (6 (3-9)) was significantly higher than other groups (p < 0.01). The grade scores for basal ganglia PVS (BG-PVS) were positively correlated with the degree of DMV (R = 0.67, p < 0.01), rather than centrum semivole PVS (CS-PVS) (R = 0.17, p = 0.1). In multivariate analysis, high CMB burden (adjusted odds ratio [aOR], 25.38; 95% confidence interval [CI], 1.87-345.23) was associated with severe DMV scores. In addition, BG-PVS was related to severe DMV burden in a dose-dependent manner: when BG-PVS score was 3 and 4, the aORs of severe DMV burden were 18.5 and 12.19, respectively. CONCLUSION The DMV impairment was associated with the severity of cSVD, which suggests that DMV burden may be used for risk stratification in SVO-AIS patients. CLINICAL RELEVANCE STATEMENT The DMV damage score, based on the association between small vessel disease and the deep medullary veins impairment, is a potential new imaging biomarker for the prognosis of small vessel occlusion acute ischemic stroke, with clinical management implications. KEY POINTS • The damage to the deep medullary vein may be one mechanism of cerebral small vessel disease. • Severe burden of the basal ganglia perivascular space and cerebral microbleed is closely associated with significant impairment to the deep medullary vein. • The deep medullary vein damage score may reflect a risk of added vascular damage in small vessel occlusion acute ischemic stroke patients.
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Affiliation(s)
- Xueyang Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
- Department of Radiology, Yancheng Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine/ Yancheng Traditional Chinese Medicine Hospital, Jiangsu, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Qi Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Chenxi Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiayu Huang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Zhihua Meng
- Department of Radiology, Yuebei People's Hospital, Guangdong, China
| | - Xiaoyan Wu
- Department of Radiology, Anshan Changda Hospital, Liaoning, China
| | - Wen Chen
- Department of Radiology, Shiyan Taihe Hospital, Hubei, China
| | - Guohua Wang
- Department of Radiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Shandong, China
| | - Qingliang Niu
- Department of Radiology, WeiFang Traditional Chinese Hospital, Shandong, China
| | - Xin Li
- Department of Radiology, Jilin University Second Hospital, Shandong, China
| | - Yitong Bian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Dan Han
- Department of Radiology, Kunming Medical University First Affiliated Hospital, Yunnan, China
| | - Weiting Guo
- Department of Radiology, Shanxi Provincial People's Hospital, Shanxi, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital Central South University, Hunan, China
| | - Xiangbing Bian
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Yina Lan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Liuxian Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Tingyang Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China.
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Han Y, Chen H, Cao X, Yin X, Zhang J. A novel perspective for exploring the relationship between cerebral small vessel disease and deep medullary veins with automatic segmentation. Clin Radiol 2024; 79:e933-e940. [PMID: 38670919 DOI: 10.1016/j.crad.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This study aimed to establish an intelligent segmentation algorithm to count the number of deep medullary veins (DMVs) and analyze the relationship between DMVs and imaging markers of cerebral small vessel disease (CSVD). METHODS DMVs on magnetic resonance imaging (MRI) of patients with CSVD were counted by intelligent segmentation and manual counting. The dice coefficient and intraclass correlation coefficient (ICC) were used to evaluate their consistency and correlation. Structural MR images were used to assess imaging markers and total burden of CSVD. A multivariate linear regression model was used to evaluate the correlation between the number of DMVs counted by intelligent segmentation and imaging markers of CSVD, including white matter hyperintensities of the presumed vascular origin, lacune, perivascular spaces, cerebral microbleeds, and total CSVD burden. RESULTS A total of 305 patients with CSVD were enrolled. An intelligent segmentation algorithm was established to calculate the number of DMVs, and it was validated and tested. The number of DMVs counted intelligently significantly correlated with the manual counting method (r = 0.761, P< 0.001). The number of smart-counted DMVs negatively correlated with the imaging markers and total burden of CSVD (P< 0.001), and the correlation remained after adjusting for age and hypertension (P< 0.05). CONCLUSIONS The proposed intelligent segmentation algorithm, which was established to count DMVs, can provide objective and quantitative imaging information for the follow-up of patients with CSVD. DMVs are involved in CSVD pathogenesis and a likely new imaging marker for CSVD.
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Affiliation(s)
- Y Han
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - H Chen
- Academy for Engineering and Technology, Fudan University, Shanghai 200040, China
| | - X Cao
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - X Yin
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - J Zhang
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200040, China.
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Miller LR, Bickel MA, Vance ML, Vaden H, Nagykaldi D, Nyul-Toth A, Bullen EC, Gautam T, Tarantini S, Yabluchanskiy A, Kiss T, Ungvari Z, Conley SM. Vascular smooth muscle cell-specific Igf1r deficiency exacerbates the development of hypertension-induced cerebral microhemorrhages and gait defects. GeroScience 2024; 46:3481-3501. [PMID: 38388918 PMCID: PMC11009188 DOI: 10.1007/s11357-024-01090-7] [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: 12/05/2023] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Cerebrovascular fragility and cerebral microhemorrhages (CMH) contribute to age-related cognitive impairment, mobility defects, and vascular cognitive impairment and dementia, impairing healthspan and reducing quality of life in the elderly. Insulin-like growth factor 1 (IGF-1) is a key vasoprotective growth factor that is reduced during aging. Circulating IGF-1 deficiency leads to the development of CMH and other signs of cerebrovascular dysfunction. Here our goal was to understand the contribution of IGF-1 signaling on vascular smooth muscle cells (VSMCs) to the development of CMH and associated gait defects. We used an inducible VSMC-specific promoter and an IGF-1 receptor (Igf1r) floxed mouse line (Myh11-CreERT2 Igf1rf/f) to knockdown Igf1r. Angiotensin II in combination with L-NAME-induced hypertension was used to elicit CMH. We observed that VSMC-specific Igf1r knockdown mice had accelerated development of CMH, and subsequent associated gait irregularities. These phenotypes were accompanied by upregulation of a cluster of pro-inflammatory genes associated with VSMC maladaptation. Collectively our findings support an essential role for VSMCs as a target for the vasoprotective effects of IGF-1, and suggest that VSMC dysfunction in aging may contribute to the development of CMH.
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Affiliation(s)
- Lauren R Miller
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
- Currently at: Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Marisa A Bickel
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Michaela L Vance
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Hannah Vaden
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Domonkos Nagykaldi
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Adam Nyul-Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Elizabeth C Bullen
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA
| | - Tripti Gautam
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Tamas Kiss
- Pediatric Center, Semmelweis University, Budapest, Hungary
- Eötvös Loránd Research Network and Semmelweis University Cerebrovascular and Neurocognitive Disorders Research Group, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon M Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd, BMSB 553, Oklahoma City, OK, 73104, USA.
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
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Yang Q, Vazquez AL, Cui XT. Revealing in vivo cellular mechanisms of cerebral microbleeds on neurons and microglia across cortical layers. iScience 2024; 27:109371. [PMID: 38510113 PMCID: PMC10951986 DOI: 10.1016/j.isci.2024.109371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Cerebral microbleeds (CMBs) are associated with higher risk for various neurological diseases including stroke, dementia, and Alzheimer's disease. However, the understanding of cellular pathology of CMBs, particularly in deep brain regions, remains limited. Utilizing two-photon microscopy and microprism implantation, we longitudinally imaged the impact of CMBs on neuronal and microglial activities across cortical depths in awake mice. A temporary decline in spontaneous neuronal activity occurred throughout cortical layers, followed by recovery within a week. However, significant changes of neuron-neuron activity correlations persisted for weeks. Moreover, microglial contact with neuron soma significantly increased post-microbleeds, indicating an important modulatory role of microglia. Notably, microglial contact, negatively correlated with neuronal firing rate in normal conditions, became uncorrelated after microbleeds, suggesting a decreased neuron-microglia inhibition. These findings reveal chronic alterations in cortical neuronal networks and microglial-neuronal interactions across cortical depths, shedding light on the pathology of CMBs.
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Affiliation(s)
- Qianru Yang
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Alberto L. Vazquez
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - X. Tracy Cui
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Ventura-Antunes L, Nackenoff A, Romero-Fernandez W, Bosworth AM, Prusky A, Wang E, Carvajal-Tapia C, Shostak A, Harmsen H, Mobley B, Maldonado J, Solopova E, Caleb Snider J, David Merryman W, Lippmann ES, Schrag M. Arteriolar degeneration and stiffness in cerebral amyloid angiopathy are linked to β-amyloid deposition and lysyl oxidase. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.08.583563. [PMID: 38659767 PMCID: PMC11042178 DOI: 10.1101/2024.03.08.583563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is a vasculopathy characterized by vascular β-amyloid (Aβ) deposition on cerebral blood vessels. CAA is closely linked to Alzheimer's disease (AD) and intracerebral hemorrhage. CAA is associated with the loss of autoregulation in the brain, vascular rupture, and cognitive decline. To assess morphological and molecular changes associated with the degeneration of penetrating arterioles in CAA, we analyzed post-mortem human brain tissue from 26 patients with mild, moderate, and severe CAA end neurological controls. The tissue was optically cleared for three-dimensional light sheet microscopy, and morphological features were quantified using surface volume rendering. We stained Aβ, vascular smooth muscle (VSM), lysyl oxidase (LOX), and vascular markers to visualize the relationship between degenerative morphological features, including vascular dilation, dolichoectasia (variability in lumenal diameter) and tortuosity, and the volumes of VSM, Aβ, and LOX in arterioles. Atomic force microscopy (AFM) was used to assess arteriolar wall stiffness, and we identified a pattern of morphological features associated with degenerating arterioles in the cortex. The volume of VSM associated with the arteriole was reduced by around 80% in arterioles with severe CAA and around 60% in cases with mild/moderate CAA. This loss of VSM correlated with increased arteriolar diameter and variability of diameter, suggesting VSM loss contributes to arteriolar laxity. These vascular morphological features correlated strongly with Aβ deposits. At sites of microhemorrhage, Aβ was consistently present, although the morphology of the deposits changed from the typical organized ring shape to sharply contoured shards with marked dilation of the vessel. AFM showed that arteriolar walls with CAA were more than 400% stiffer than those without CAA. Finally, we characterized the association of vascular degeneration with LOX, finding strong associations with VSM loss and vascular degeneration. These results show an association between vascular Aβ deposition, microvascular degeneration, and increased vascular stiffness, likely due to the combined effects of replacement of VSM by β-amyloid, cross-linking of extracellular matrices (ECM) by LOX, and possibly fibrosis. This advanced microscopic imaging study clarifies the association between Aβ deposition and vascular fragility. Restoration of physiologic ECM properties in penetrating arteries may yield a novel therapeutic strategy for CAA.
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Affiliation(s)
| | - Alex Nackenoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Allison M Bosworth
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Alex Prusky
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emmeline Wang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alena Shostak
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hannah Harmsen
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bret Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jose Maldonado
- Vanderbilt Neurovisualization Lab, Vanderbilt University, Nashville, TN, USA
| | - Elena Solopova
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J. Caleb Snider
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - W. David Merryman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Ethan S Lippmann
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville TN, USA
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN, USA
| | - Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville TN, USA
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Bonney SK, Nielson CD, Sosa MJ, Shih AY. Capillary regression leads to sustained local hypoperfusion by inducing constriction of upstream transitional vessels. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.28.564529. [PMID: 37961686 PMCID: PMC10635020 DOI: 10.1101/2023.10.28.564529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
In the brain, a microvascular sensory web coordinates oxygen delivery to regions of neuronal activity. This involves a dense network of capillaries that send conductive signals upstream to feeding arterioles to promote vasodilation and blood flow. Although this process is critical to the metabolic supply of healthy brain tissue, it may also be a point of vulnerability in disease. Deterioration of capillary networks is a hallmark of many neurological disorders and how this web is engaged during vascular damage remains unknown. We performed in vivo two-photon microscopy on young adult mural cell reporter mice and induced focal capillary injuries using precise two-photon laser irradiation of single capillaries. We found that ∼63% of the injuries resulted in regression of the capillary segment 7-14 days following injury, and the remaining repaired to re-establish blood flow within 7 days. Injuries that resulted in capillary regression induced sustained vasoconstriction in the upstream arteriole-capillary transition (ACT) zone at least 21 days post-injury in both awake and anesthetized mice. This abnormal vasoconstriction involved attenuation of vasomotor dynamics and uncoupling from mural cell calcium signaling following capillary regression. Consequently, blood flow was reduced in the ACT zone and in secondary, uninjured downstream capillaries. These findings demonstrate how capillary injury and regression, as often seen in age-related neurological disease, can impair the microvascular sensory web and contribute to cerebral hypoperfusion. SIGNIFICANCE Deterioration of the capillary network is a characteristic of many neurological diseases and can exacerbate neuronal dysfunction and degeneration due to poor blood perfusion. Here we show that focal capillary injuries can induce vessel regression and elicit sustained vasoconstriction in upstream transitional vessels that branch from cortical penetrating arterioles. This reduces blood flow to broader, uninjured regions of the same microvascular network. These findings suggest that widespread and cumulative damage to brain capillaries in neurological disease may broadly affect blood supply and contribute to hypoperfusion through their remote actions.
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Zhang H, Sumbria RK, Chang R, Sun J, Cribbs DH, Holmes TC, Fisher MJ, Xu X. Erythrocyte-brain endothelial interactions induce microglial responses and cerebral microhemorrhages in vivo. J Neuroinflammation 2023; 20:265. [PMID: 37968737 PMCID: PMC10647121 DOI: 10.1186/s12974-023-02932-5] [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: 07/18/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Cerebral microhemorrhages (CMH) are associated with stroke, cognitive decline, and normal aging. Our previous study shows that the interaction between oxidatively stressed red blood cells (RBC) and cerebral endothelium may underlie CMH development. However, the real-time examination of altered RBC-brain endothelial interactions in vivo, and their relationship with clearance of stalled RBC, microglial responses, and CMH development, has not been reported. METHODS RBC were oxidatively stressed using tert-butylhydroperoxide (t-BHP), fluorescently labeled and injected into adult Tie2-GFP mice. In vivo two-photon imaging and ex vivo confocal microscopy were used to evaluate the temporal profile of RBC-brain endothelial interactions associated with oxidatively stressed RBC. Their relationship with microglial activation and CMH was examined with post-mortem histology. RESULTS Oxidatively stressed RBC stall significantly and rapidly in cerebral vessels in mice, accompanied by decreased blood flow velocity which recovers at 5 days. Post-mortem histology confirms significantly greater RBC-cerebral endothelial interactions and microglial activation at 24 h after t-BHP-treated RBC injection, which persist at 7 days. Furthermore, significant CMH develop in the absence of blood-brain barrier leakage after t-BHP-RBC injection. CONCLUSIONS Our in vivo and ex vivo findings show the stalling and clearance of oxidatively stressed RBC in cerebral capillaries, highlighting the significance of microglial responses and altered RBC-brain endothelial interactions in CMH development. Our study provides novel mechanistic insight into CMH associated with pathological conditions with increased RBC-brain endothelial interactions.
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Affiliation(s)
- Hai Zhang
- Department of Anatomy and Neurobiology, School of Medicine, University of California, Irvine, CA, 92697, USA
| | - Rachita K Sumbria
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, 92618, USA.
- Department of Neurology, University of California, Irvine, CA, 92697, USA.
| | - Rudy Chang
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, 92618, USA
| | - Jiahong Sun
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, 92618, USA
| | - David H Cribbs
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, 92697, USA
| | - Todd C Holmes
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, 92697, USA
- Center for Neural Circuit Mapping, University of California, Irvine, CA, 92697, USA
| | - Mark J Fisher
- Department of Anatomy and Neurobiology, School of Medicine, University of California, Irvine, CA, 92697, USA.
- Department of Neurology, University of California, Irvine, CA, 92697, USA.
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, 92697, USA.
- Center for Neural Circuit Mapping, University of California, Irvine, CA, 92697, USA.
- Beckman Laser Institute, University of California, Irvine, CA, 92697, USA.
- Department of Pathology & Laboratory Medicine, University of California, Irvine, CA, 92697, USA.
| | - Xiangmin Xu
- Department of Anatomy and Neurobiology, School of Medicine, University of California, Irvine, CA, 92697, USA.
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, 92697, USA.
- Center for Neural Circuit Mapping, University of California, Irvine, CA, 92697, USA.
- Department of Biomedical Engineering, University of California, Irvine, CA, 92697, USA.
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10
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Faakye J, Nyúl-Tóth Á, Gulej R, Csik B, Tarantini S, Shanmugarama S, Prodan C, Mukli P, Yabluchanskiy A, Conley S, Toth P, Csiszar A, Ungvari Z. Imaging the time course, morphology, neuronal tissue compression, and resolution of cerebral microhemorrhages in mice using intravital two-photon microscopy: insights into arteriolar, capillary, and venular origin. GeroScience 2023; 45:2851-2872. [PMID: 37338779 PMCID: PMC10643488 DOI: 10.1007/s11357-023-00839-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
Cerebral microhemorrhages (CMHs, microbleeds), a manifestation of age-related cerebral small vessel disease, contribute to the pathogenesis of cognitive decline and dementia in older adults. Histological studies have revealed that CMHs exhibit distinct morphologies, which may be attributed to differences in intravascular pressure and the size of the vessels of origin. Our study aimed to establish a direct relationship between the size/morphology of CMHs and the size/anatomy of the microvessel of origin. To achieve this goal, we adapted and optimized intravital two-photon microscopy-based imaging methods to monitor the development of CMHs in mice equipped with a chronic cranial window upon high-energy laser light-induced photodisruption of a targeted cortical arteriole, capillary, or venule. We assessed the time course of extravasation of fluorescently labeled blood and determined the morphology and size/volume of the induced CMHs. Our findings reveal striking similarities between the bleed morphologies observed in hypertension-induced CMHs in models of aging and those originating from different targeted vessels via multiphoton laser ablation. Arteriolar bleeds, which are larger (> 100 μm) and more widely dispersed, are distinguished from venular bleeds, which are smaller and exhibit a distinct diffuse morphology. Capillary bleeds are circular and smaller (< 10 μm) in size. Our study supports the concept that CMHs can occur at any location in the vascular tree, and that each type of vessel produces microbleeds with a distinct morphology. Development of CMHs resulted in immediate constriction of capillaries, likely due to pericyte activation and constriction of precapillary arterioles. Additionally, tissue displacement observed in association with arteriolar CMHs suggests that they can affect an area with a radius of ~ 50 μm to ~ 100 μm, creating an area at risk for ischemia. Longitudinal imaging of CMHs allowed us to visualize reactive astrocytosis and bleed resolution during a 30-day period. Our study provides new insights into the development and morphology of CMHs, highlighting the potential clinical implications of differentiating between the types of vessels involved in the pathogenesis of CMHs. This information may help in the development of targeted interventions aimed at reducing the risk of cerebral small vessel disease-related cognitive decline and dementia in older adults.
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Affiliation(s)
- Janet Faakye
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ádám Nyúl-Tóth
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Boglarka Csik
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Santny Shanmugarama
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peter Mukli
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peter Toth
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA.
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11
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Zedde M, Grisendi I, Assenza F, Vandelli G, Napoli M, Moratti C, Lochner P, Seiffge DJ, Piazza F, Valzania F, Pascarella R. The Venular Side of Cerebral Amyloid Angiopathy: Proof of Concept of a Neglected Issue. Biomedicines 2023; 11:2663. [PMID: 37893037 PMCID: PMC10604278 DOI: 10.3390/biomedicines11102663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteries, arterioles, capillaries, and venules in the brain. One of the most relevant and prevalent SVDs is cerebral amyloid angiopathy (CAA), whose pathological hallmark is the deposition of amyloid fragments in the walls of small cortical and leptomeningeal vessels. CAA frequently coexists with Alzheimer's Disease (AD), and both are associated with cerebrovascular events, cognitive impairment, and dementia. CAA and AD share pathophysiological, histopathological and neuroimaging issues. The venular involvement in both diseases has been neglected, although both animal models and human histopathological studies found a deposition of amyloid beta in cortical venules. This review aimed to summarize the available information about venular involvement in CAA, starting from the biological level with the putative pathomechanisms of cerebral damage, passing through the definition of the peculiar angioarchitecture of the human cortex with the functional organization and consequences of cortical arteriolar and venular occlusion, and ending to the hypothesized links between cortical venular involvement and the main neuroimaging markers of the disease.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Gabriele Vandelli
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, 66421 Homburg, Germany;
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy;
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
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12
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Wang D, Xiang Y, Peng Y, Zeng P, Zeng B, Chai Y, Li Y. Deep Medullary Vein and MRI Markers Were Related to Cerebral Hemorrhage Subtypes. Brain Sci 2023; 13:1315. [PMID: 37759916 PMCID: PMC10526710 DOI: 10.3390/brainsci13091315] [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: 07/18/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To explore the performance of deep medullary vein (DMV) and magnetic resonance imaging (MRI) markers in different intracerebral hemorrhage (ICH) subtypes in patients with cerebral small vessel disease (CSVD). METHODS In total, 232 cases of CSVD with ICH were included in this study. The clinical and image data were retrospectively analyzed. Patients were divided into hypertensive arteriopathy (HTNA)-related ICH, cerebral amyloid angiopathy (CAA)-related ICH, and mixed ICH groups. The DMV score was determined in the cerebral hemisphere contralateral to the ICH. RESULTS The DMV score was different between the HTNA-related and mixed ICH groups (p < 0.01). The MRI markers and CSVD burden score were significant among the ICH groups (p < 0.05). Compared to mixed ICH, HTNA-related ICH diagnosis was associated with higher deep white matter hyperintensity (DWMH) (OR: 0.452, 95% CI: 0.253-0.809, p < 0.05) and high-degree perivascular space (PVS) (OR: 0.633, 95% CI: 0.416-0.963, p < 0.05), and CAA-related ICH diagnosis was associated with increased age (OR: 1.074; 95% CI: 1.028-1.122, p = 0.001). The DMV score correlated with cerebral microbleed (CMB), PVS, DWMH, periventricular white matter hyperintensity (PWMH), and CSVD burden score (p < 0.05) but not with lacuna (p > 0.05). Age was an independent risk factor for the severity of DMV score (OR: 1.052; 95% CI: 0.026-0.076, p < 0.001). CONCLUSION DMV scores, CSVD markers, and CSVD burden scores were associated with different subtypes of ICH. In addition, DMV scores were associated with the severity of CSVD and CSVD markers.
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Affiliation(s)
- Dan Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
- Department of Radiology, Mianyang Central Hospital, 12# Changjia Lane, Mianyang 621000, China
| | - Yayun Xiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Yuling Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Peng Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Bang Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
| | - Ying Chai
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
- Department of Radiology, People’s Hospital of Shapingba District, 44# Xiaolongkan New Street, Chongqing 400010, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuan Jiagang, Chongqing 400010, China
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13
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Kaw K, Chattopadhyay A, Guan P, Chen J, Majumder S, Duan XY, Ma S, Zhang C, Kwartler CS, Milewicz DM. Smooth muscle α-actin missense variant promotes atherosclerosis through modulation of intracellular cholesterol in smooth muscle cells. Eur Heart J 2023; 44:2713-2726. [PMID: 37377039 PMCID: PMC10393072 DOI: 10.1093/eurheartj/ehad373] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/15/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
AIMS The variant p.Arg149Cys in ACTA2, which encodes smooth muscle cell (SMC)-specific α-actin, predisposes to thoracic aortic disease and early onset coronary artery disease in individuals without cardiovascular risk factors. This study investigated how this variant drives increased atherosclerosis. METHODS AND RESULTS Apoe-/- mice with and without the variant were fed a high-fat diet for 12 weeks, followed by evaluation of atherosclerotic plaque formation and single-cell transcriptomics analysis. SMCs explanted from Acta2R149C/+ and wildtype (WT) ascending aortas were used to investigate atherosclerosis-associated SMC phenotypic modulation. Hyperlipidemic Acta2R149C/+Apoe-/- mice have a 2.5-fold increase in atherosclerotic plaque burden compared to Apoe-/- mice with no differences in serum lipid levels. At the cellular level, misfolding of the R149C α-actin activates heat shock factor 1, which increases endogenous cholesterol biosynthesis and intracellular cholesterol levels through increased HMG-CoA reductase (HMG-CoAR) expression and activity. The increased cellular cholesterol in Acta2R149C/+ SMCs induces endoplasmic reticulum stress and activates PERK-ATF4-KLF4 signaling to drive atherosclerosis-associated phenotypic modulation in the absence of exogenous cholesterol, while WT cells require higher levels of exogenous cholesterol to drive phenotypic modulation. Treatment with the HMG-CoAR inhibitor pravastatin successfully reverses the increased atherosclerotic plaque burden in Acta2R149C/+Apoe-/- mice. CONCLUSION These data establish a novel mechanism by which a pathogenic missense variant in a smooth muscle-specific contractile protein predisposes to atherosclerosis in individuals without hypercholesterolemia or other risk factors. The results emphasize the role of increased intracellular cholesterol levels in driving SMC phenotypic modulation and atherosclerotic plaque burden.
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Affiliation(s)
- Kaveeta Kaw
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Abhijnan Chattopadhyay
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Pujun Guan
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Jiyuan Chen
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Suravi Majumder
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Xue-yan Duan
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Shuangtao Ma
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
- Department of Medicine, Michigan State University, 1355 Bogue St, B226B Life Sciences, East Lansing, MI 48824, USA
| | - Chen Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and Department of Cardiovascular Surgery, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX 77030, USA
| | - Callie S Kwartler
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
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14
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Wu L, Huang H, Yu Z, Luo X, Xu S. Asymmetry of Lacunae between Brain Hemispheres Is Associated with Atherosclerotic Occlusions of Middle Cerebral Artery. Brain Sci 2023; 13:1016. [PMID: 37508948 PMCID: PMC10377170 DOI: 10.3390/brainsci13071016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Cerebral small vessel disease (CSVD) commonly coexists with intracranial atherosclerotic stenosis (ICAS). Previous studies have tried to evaluate the relationship between ICAS and CSVD; however, they have yielded varied conclusions. Furthermore, the methodology of these studies is not very rigorous, as they have evaluated the association between ICAS and CSVD of bilateral hemispheres rather than the affected hemisphere. Unilateral middle cerebral artery atherosclerotic occlusion (uni-MCAO) is a favorable model to solve this problem. MATERIAL AND METHODS Patients with uni-MCAO were retrospectively observed. Imaging characteristics, including lacunae, white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMBs), were compared between the hemisphere ipsilateral to the MCAO and the contralateral hemisphere. RESULTS A total of 219 patients (median age 57 years; 156 males) were enrolled. Compared with the contralateral side, increased quality of lacunae (median, IQR, 0, 2 vs. 0, 1; p < 0.001) and elevated CSVD score (median, IQR, 0, 1 vs. 0, 1; p = 0.004) were found in the occluded hemisphere. No significant differences were shown for WMH, EPVS, and CMBs. CONCLUSIONS Uni-MCAO has a higher prevalence of lacunae in the ipsilateral hemisphere. However, no interhemispheric differences in WMH, EPVS, or CMBs were found.
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Affiliation(s)
- Lingshan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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15
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Mao HJ, Zhang JX, Zhu WC, Zhang H, Fan XM, Han F, Ni J, Zhou LX, Yao M, Tian F, Su N, Zhu YC. Basal Ganglia and Brainstem Located Cerebral Microbleeds Contributed to Gait Impairment in Patients with Cerebral Small Vessel Disease. J Alzheimers Dis 2023:JAD230005. [PMID: 37355892 DOI: 10.3233/jad-230005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND The mechanism of gait disorder in patients with cerebral small vessel disease (CSVD) remains unclear. Limited studies have compared the effect of cerebral microbleeds (CMBs) and lacunes on gait disturbance in CSVD patients in different anatomical locations. OBJECTIVE To investigate the relationship of quantitative gait parameters with varied anatomically located MRI imaging markers in patients with CSVD. METHODS Quantitative gait tests were performed on 127 symptomatic CSVD patients all with diffuse distributed white matter hyperintensities (WMHs). CMBs and lacunes in regard to anatomical locations and burdens were measured. The correlation between CSVD imaging markers and gait parameters was evaluated using general linear model analysis. RESULTS Presence of CMBs was significantly associated with stride length (β= -0.098, p = 0.0272) and right step length (β= -0.054, p = 0.0206). Presence of CMBs in basal ganglia (BG) was significantly associated with stride length and step length. Presence of CMBs in brainstem was significantly associated with gait parameters including stride length, step length, step height, and step width. Presence of lacunes in brainstem was significantly associated with gait speed (β= -0.197, p = 0.0365). However, presence of lacunes in the other areas was not associated with worse gait performances. CONCLUSION BG and brain stem located CMBs contributed to gait impairment in symptomatic CSVD patients.
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Affiliation(s)
- He-Jiao Mao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiang-Xia Zhang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wen-Cheng Zhu
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Hao Zhang
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Xiang-Min Fan
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Feng Tian
- State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Ning Su
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Wan H, Chen H, Zhang M, Feng T, Wang Y. Cerebral microbleeds is associated with dementia in Parkinson's disease. Acta Neurol Belg 2023; 123:407-413. [PMID: 35672560 DOI: 10.1007/s13760-022-01918-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Emerging evidence suggests that cerebral small vessel disease (CSVD) may worsen cognitive functions in Parkinson's disease (PD). However, the effect of microbleeds on cognitive function in patients with PD remains unknown. This study explored the association between the presence, number and location of microbleeds with dementia in PD patients. METHODS This cross-sectional study included 431 patients with PD from Beijing Tiantan Hospital from May 2016 to August 2019. Cognition assessments (MMSE, MoCA) were performed for these patients. MRI imaging sequences were obtained and reviewed independently by two well-trained readers who were blind to all clinical data. Spearman's correlation analysis and logistic regression model analysis were further used for the assessments. RESULTS An association between cerebral microbleeds with cognitive ability and dementia in PD patients was revealed. A significance was observed between the total number of microbleeds and two widely used scores of cognitive assessments (Spearman R = - 0.120 to MMSE with a p = 0.016, and - 0.117 to MoCA with a p = 0.020). In detail, infratentorial microbleeds were associated with the level of cognition in PD patients (Spearman R = - 0.099 to MMSE with a p = 0.049, and - 0.116 to MoCA with a p = 0.021). Furthermore, logistic regression analysis results also confirmed such correlations between the number of microbleeds and cognitive ability after adjusting for age, cholesterol level, Hamilton Anxiety Scale, Hamilton Depression Scale, and white matter hyperintensity Fazekas score (OR 3.28, p = 0.035, 95% CI 1.090-9.892). CONCLUSIONS The occurrence of microbleeds, especially in the infratentorial locations, may worsen the cognitive function of PD patients and result in dementia. Management of cerebral vascular disease could be beneficial to patients with PD.
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Affiliation(s)
- Huijuan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
- Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Huimin Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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17
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Magaki S, Chen Z, Severance A, Williams CK, Diaz R, Fang C, Khanlou N, Yong WH, Paganini-Hill A, Kalaria RN, Vinters HV, Fisher M. Neuropathology of microbleeds in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). J Neuropathol Exp Neurol 2023; 82:333-344. [PMID: 36715085 PMCID: PMC10025882 DOI: 10.1093/jnen/nlad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cerebral microbleeds (CMBs) detected on magnetic resonance imaging are common in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The neuropathologic correlates of CMBs are unclear. In this study, we characterized findings relevant to CMBs in autopsy brain tissue of 8 patients with genetically confirmed CADASIL and 10 controls within the age range of the CADASIL patients by assessing the distribution and extent of hemosiderin/iron deposits including perivascular hemosiderin leakage (PVH), capillary hemosiderin deposits, and parenchymal iron deposits (PID) in the frontal cortex and white matter, basal ganglia and cerebellum. We also characterized infarcts, vessel wall thickening, and severity of vascular smooth muscle cell degeneration. CADASIL subjects had a significant increase in hemosiderin/iron deposits compared with controls. This increase was principally seen with PID. Hemosiderin/iron deposits were seen in the majority of CADASIL subjects in all brain areas. PVH was most pronounced in the frontal white matter and basal ganglia around small to medium sized arterioles, with no predilection for the vicinity of vessels with severe vascular changes or infarcts. CADASIL subjects have increased brain hemosiderin/iron deposits but these do not occur in a periarteriolar distribution. Pathogenesis of these lesions remains uncertain.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Zesheng Chen
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Alyscia Severance
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Christopher K Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Ramiro Diaz
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Chuo Fang
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Negar Khanlou
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - William H Yong
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Brain Research Institute, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Mark Fisher
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, California, USA
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18
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Fang C, Lau WL, Sun J, Chang R, Vallejo A, Lee D, Liu J, Liu H, Hung YH, Zhao Y, Paganini-Hill A, Sumbria RK, Cribbs DH, Fisher M. Chronic kidney disease promotes cerebral microhemorrhage formation. J Neuroinflammation 2023; 20:51. [PMID: 36841828 PMCID: PMC9960195 DOI: 10.1186/s12974-023-02703-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/20/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is increasingly recognized as a stroke risk factor, but its exact relationship with cerebrovascular disease is not well-understood. We investigated the development of cerebral small vessel disease using in vivo and in vitro models of CKD. METHODS CKD was produced in aged C57BL/6J mice using an adenine-induced tubulointerstitial nephritis model. We analyzed brain histology using Prussian blue staining to examine formation of cerebral microhemorrhage (CMH), the hemorrhagic component of small vessel disease and the neuropathological substrate of MRI-demonstrable cerebral microbleeds. In cell culture studies, we examined effects of serum from healthy or CKD patients and gut-derived uremic toxins on brain microvascular endothelial barrier. RESULTS CKD was induced in aged C57BL/6J mice with significant increases in both serum creatinine and cystatin C levels (p < 0.0001) without elevation of systolic or diastolic blood pressure. CMH was significantly increased and positively correlated with serum creatinine level (Spearman r = 0.37, p < 0.01). Moreover, CKD significantly increased Iba-1-positive immunoreactivity by 51% (p < 0.001), induced a phenotypic switch from resting to activated microglia, and enhanced fibrinogen extravasation across the blood-brain barrier (BBB) by 34% (p < 0.05). On analysis stratified by sex, the increase in CMH number was more pronounced in male mice and this correlated with greater creatinine elevation in male compared with female mice. Microglial depletion with PLX3397 diet significantly decreased CMH formation in CKD mice without affecting serum creatinine levels. Incubation of CKD serum significantly reduced transendothelial electrical resistance (TEER) (p < 0.01) and increased sodium fluorescein permeability (p < 0.05) across the endothelial monolayer. Uremic toxins (i.e., indoxyl sulfate, p-cresyl sulfate, and trimethylamine-N-oxide) in combination with urea and lipopolysaccharide induced a marked drop in TEER compared with the control group (p < 0.0001). CONCLUSIONS CKD promotes the development of CMH in aged mice independent of blood pressure but directly proportional to the degree of renal impairment. These effects of CKD are likely mediated in part by microglia and are associated with BBB impairment. The latter is likely related to gut-derived bacteria-dependent toxins classically associated with CKD. Overall, these findings demonstrate an important role of CKD in the development of cerebral small vessel disease.
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Affiliation(s)
- Chuo Fang
- Department of Neurology, University of California, Irvine, CA, USA
| | - Wei Ling Lau
- Department of Medicine, Division of Nephrology, University of California, Irvine, CA, USA
| | - Jiahong Sun
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Rudy Chang
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Adrian Vallejo
- Department of Neurology, University of California, Irvine, CA, USA
| | - Donghy Lee
- Department of Neurology, University of California, Irvine, CA, USA
| | - Jihua Liu
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Han Liu
- Department of Medicine, Division of Nephrology, University of California, Irvine, CA, USA
| | - Yu-Han Hung
- Department of Neurology, University of California, Irvine, CA, USA
| | - Yitong Zhao
- Department of Medicine, Division of Nephrology, University of California, Irvine, CA, USA
| | | | - Rachita K Sumbria
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - David H Cribbs
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Mark Fisher
- Department of Neurology, University of California, Irvine, CA, USA.
- Department of Pathology & Laboratory Medicine, University of California, Irvine, CA, USA.
- Department of Neurology, UC Irvine Medical Center, 101 The City Drive South, Shanbrom Hall (Building 55), Room 121, Orange, CA, 92868, USA.
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19
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Exploring the Impact of Cerebral Microbleeds on Stroke Management. Neurol Int 2023; 15:188-224. [PMID: 36810469 PMCID: PMC9944881 DOI: 10.3390/neurolint15010014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. In the present review, we evaluated whether CMBs affect ischemic and hemorrhagic stroke outcomes and explored the fundamental question of whether CMBs may shift the risk-benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. A literature review of two databases (MEDLINE and Scopus) was conducted to identify all the relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles were traced and included in the present review. Our findings highlight the utility of CMB assessments, not only in the prognostication of hemorrhagic complications of reperfusion therapy, but also in forecasting hemorrhagic and ischemic stroke patients' functional outcomes, thus indicating that a biomarker-based approach may aid in the provision of counseling for patients and families, improve the selection of more appropriate medical therapies, and contribute to a more accurate choice of patients for reperfusion therapy.
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20
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Mitra J, Kodavati M, Provasek VE, Rao KS, Mitra S, Hamilton DJ, Horner PJ, Vahidy FS, Britz GW, Kent TA, Hegde ML. SARS-CoV-2 and the central nervous system: Emerging insights into hemorrhage-associated neurological consequences and therapeutic considerations. Ageing Res Rev 2022; 80:101687. [PMID: 35843590 PMCID: PMC9288264 DOI: 10.1016/j.arr.2022.101687] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 01/27/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to impact our lives by causing widespread illness and death and poses a threat due to the possibility of emerging strains. SARS-CoV-2 targets angiotensin-converting enzyme 2 (ACE2) before entering vital organs of the body, including the brain. Studies have shown systemic inflammation, cellular senescence, and viral toxicity-mediated multi-organ failure occur during infectious periods. However, prognostic investigations suggest that both acute and long-term neurological complications, including predisposition to irreversible neurodegenerative diseases, can be a serious concern for COVID-19 survivors, especially the elderly population. As emerging studies reveal sites of SARS-CoV-2 infection in different parts of the brain, potential causes of chronic lesions including cerebral and deep-brain microbleeds and the likelihood of developing stroke-like pathologies increases, with critical long-term consequences, particularly for individuals with neuropathological and/or age-associated comorbid conditions. Our recent studies linking the blood degradation products to genome instability, leading to cellular senescence and ferroptosis, raise the possibility of similar neurovascular events as a result of SARS-CoV-2 infection. In this review, we discuss the neuropathological consequences of SARS-CoV-2 infection in COVID survivors, focusing on possible hemorrhagic damage in brain cells, its association to aging, and the future directions in developing mechanism-guided therapeutic strategies.
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Affiliation(s)
- Joy Mitra
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA.
| | - Manohar Kodavati
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Vincent E Provasek
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; College of Medicine, Texas A&M University, College Station, TX, USA
| | - K S Rao
- Department of Biotechnology, Koneru Lakshmaiah Education Foundation Deemed to be University, Green Fields, Vaddeswaram, Andhra Pradesh 522502, India
| | - Sankar Mitra
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Dale J Hamilton
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA
| | - Philip J Horner
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Gavin W Britz
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA
| | - Thomas A Kent
- Center for Genomics and Precision Medicine, Department of Translational Medical Sciences, Institute of Biosciences and Technology, College of Medicine, Texas A&M Health Science Center, Houston, TX, USA
| | - Muralidhar L Hegde
- Division of DNA Repair Research, Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA; Weill Cornell Medical College, New York, USA.
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21
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Diagnostic Value of Susceptibility-Weighted Imaging Combined with Diffusion-Weighted Imaging in Early Intracerebral Hemorrhage. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8072582. [PMID: 35845742 PMCID: PMC9249485 DOI: 10.1155/2022/8072582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Abstract
Objective The incidence of early intracerebral hemorrhage (ICH) is gradually increasing and has been shown to affect an increasing number of younger people. Conventional imaging modalities might have a low detection rate of early and small ICH lesions. This study aimed to investigate the diagnostic value of susceptibility-weighted imaging (SWI) combined with diffusion-weighted imaging (DWI) in early ICH. Materials and Methods The data of 61 patients with early ICH diagnosed by computed tomography (CT) scan between January 2019 and February 2020 were assessed. Using CT as the gold standard, we compared the diagnostic sensitivity, accuracy, and imaging characteristics of SWI + DWI versus SWI or DWI alone. Results A total of 78 lesions were detected by CT in 61 patients with early ICH. The diagnostic sensitivity and accuracy of SWI + DWI were significantly higher than those of SWI or DWI alone. In terms of imaging characteristics, DWI demonstrated very low signal intensity in the hematoma center at different stages of early ICH with high signal intensity in the surrounding tissue, and the signal range gradually increased over time. By contrast, SWI displayed very low signal intensity at different stages, and the signal intensity also gradually increased over time. Conclusion Compared with SWI or DWI alone, SWI combined with DWI could improve the detection rate of hematoma lesions in patients with early ICH.
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22
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Kuriyama N, Koyama T, Ozaki E, Saito S, Ihara M, Matsui D, Watanabe I, Kondo M, Marunaka Y, Takada A, Akazawa K, Tomida S, Nagamitsu R, Miyatani F, Miyake M, Nakano E, Kobayashi D, Watanabe Y, Mizuno S, Maekawa M, Yoshida T, Nukaya Y, Mizuno T, Yamada K, Uehara R. Association Between Cerebral Microbleeds and Circulating Levels of Mid-Regional Pro-Adrenomedullin. J Alzheimers Dis 2022; 88:731-741. [DOI: 10.3233/jad-220195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Mid-regional pro-adrenomedullin (MR-proADM) is a novel biomarker for cognitive decline based on its association with cerebral small vessel disease (SVD). Cerebral microbleeds (MBs) are characteristic of SVD; however, a direct association between MR-proADM and MBs has not been explored. Objective: We aimed to examine whether circulating levels of MR-proADM are associated with the identification of MBs by brain magnetic resonance imaging (MRI) and whether this association could be linked with cognitive impairment. Methods: In total, 214 participants (mean age: 75.9 years) without history of cerebral infarction or dementia were prospectively enrolled. All participants underwent brain MRI, higher cognitive function testing, blood biochemistry evaluation, lifestyle examination, and blood MR-proADM measurement using a time-resolved amplified cryptate emission technology assay. For between-group comparisons, the participants were divided into two groups according to whether their levels of MR-proADM were normal (< 0.65 nmol/L) or high (≥0.65 nmol/L). Results: The mean MR-proADM level was 0.515±0.127 nmol/L. There were significant between-group differences in age, hypertension, and HbA1c levels (p < 0.05). In the high MR-proADM group, the MR-proADM level was associated with the identification of MBs on brain MR images and indications of mild cognitive impairment (MCI). In participants with ≥3 MBs and MCI, high MR-proADM levels remained a risk factor after multivariate adjustment (OR: 2.94; p < 0.05). Conclusion: High levels of MR-proADM may be a surrogate marker for the early detection of cognitive decline associated with the formation of cerebral MBs. This marker would be valuable during routine clinical examinations of geriatric patients.
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Affiliation(s)
- Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Social Health Medicine, Shizuoka Graduate University of Public Health
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Saito
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Daisuke Matsui
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Watanabe
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Kondo
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinori Marunaka
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
- Research Center for Drug Discovery and Pharmaceutical Development Science, Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Japan
| | - Akihiro Takada
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
| | - Kentaro Akazawa
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satomi Tomida
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Reo Nagamitsu
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumitaro Miyatani
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eri Nakano
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Yoshiyuki Watanabe
- Faculty of Health and Medical Sciences, Kyoto University of Advanced Science
| | - Shigeto Mizuno
- Department of Endoscopy, Kindai University Nara Hospital, Nara Prefecture, Japan
| | - Mizuho Maekawa
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tamami Yoshida
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukiko Nukaya
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ritei Uehara
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Blood-brain barrier leakage in Alzheimer's disease: From discovery to clinical relevance. Pharmacol Ther 2022; 234:108119. [PMID: 35108575 PMCID: PMC9107516 DOI: 10.1016/j.pharmthera.2022.108119] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia. AD brain pathology starts decades before the onset of clinical symptoms. One early pathological hallmark is blood-brain barrier dysfunction characterized by barrier leakage and associated with cognitive decline. In this review, we summarize the existing literature on the extent and clinical relevance of barrier leakage in AD. First, we focus on AD animal models and their susceptibility to barrier leakage based on age and genetic background. Second, we re-examine barrier dysfunction in clinical and postmortem studies, summarize changes that lead to barrier leakage in patients and highlight the clinical relevance of barrier leakage in AD. Third, we summarize signaling mechanisms that link barrier leakage to neurodegeneration and cognitive decline in AD. Finally, we discuss clinical relevance and potential therapeutic strategies and provide future perspectives on investigating barrier leakage in AD. Identifying mechanistic steps underlying barrier leakage has the potential to unravel new targets that can be used to develop novel therapeutic strategies to repair barrier leakage and slow cognitive decline in AD and AD-related dementias.
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Du H, Yang W, Chen X. Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease. Front Neurol 2022; 12:789035. [PMID: 35140673 PMCID: PMC8818681 DOI: 10.3389/fneur.2021.789035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Xiangyan Chen
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25
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Albakr A. Spontaneous intracerebral hemorrhage among hypertensive patients in Saudi Arabia: Study from a tertiary center. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:139-145. [PMID: 35602389 PMCID: PMC9121708 DOI: 10.4103/sjmms.sjmms_73_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Objectives: Patients and Methods: Results: Conclusion:
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Wang HL, Zhang CL, Qiu YM, Chen AQ, Li YN, Hu B. Dysfunction of the Blood-brain Barrier in Cerebral Microbleeds: from Bedside to Bench. Aging Dis 2021; 12:1898-1919. [PMID: 34881076 PMCID: PMC8612614 DOI: 10.14336/ad.2021.0514] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/14/2021] [Indexed: 02/06/2023] Open
Abstract
Cerebral microbleeds (CMBs) are a disorder of cerebral microvessels that are characterized as small (<10 mm), hypointense, round or ovoid lesions seen on T2*-weighted gradient echo MRI. There is a high prevalence of CMBs in community-dwelling healthy older people. An increasing number of studies have demonstrated the significance of CMBs in stroke, dementia, Parkinson's disease, gait disturbances and late-life depression. Blood-brain barrier (BBB) dysfunction is considered to be the event that initializes CMBs development. However, the pathogenesis of CMBs has not yet been clearly elucidated. In this review, we introduce the pathogenesis of CMBs, hypertensive vasculopathy and cerebral amyloid angiopathy, and review recent research that has advanced our understanding of the mechanisms underlying BBB dysfunction and CMBs presence. CMBs-associated risk factors can exacerbate BBB breakdown through the vulnerability of BBB anatomical and functional changes. Finally, we discuss potential pharmacological approaches to target the BBB as therapy for CMBs.
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Affiliation(s)
| | | | | | - An-qi Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ya-nan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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27
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Chen H, Wang Y. Reader Response: Detection of Cerebral Microbleeds With Venous Connection at 7-Tesla MRI. Neurology 2021; 97:839-840. [PMID: 34697210 DOI: 10.1212/wnl.0000000000012736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Miwa K, Koga M, Inoue M, Yoshimura S, Sasaki M, Yakushiji Y, Fukuda-Doi M, Okada Y, Nakase T, Ihara M, Nagakane Y, Takizawa S, Asakura K, Aoki J, Kimura K, Yamamoto H, Toyoda K. Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial. Int J Stroke 2021; 17:628-636. [PMID: 34282985 DOI: 10.1177/17474930211035023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM We determined to investigate the incidence and clinical impact of new cerebral microbleeds after intravenous thrombolysis in patients with acute stroke. METHODS The THAWS was a multicenter, randomized trial to study the efficacy and safety of intravenous thrombolysis with alteplase in patients with wake-up stroke or unknown onset stroke. Prescheduled T2*-weighted imaging assessed cerebral microbleeds at three time points: baseline, 22-36 h, and 7-14 days. Outcomes included new cerebral microbleeds development, modified Rankin Scale (mRS) ≥3 at 90 days, and change in the National Institutes of Health Stroke Scale (NIHSS) score from 24 h to 7 days. RESULTS Of all 131 patients randomized in the THAWS trial, 113 patients (mean 74.3 ± 12.6 years, 50 female, 62 allocated to intravenous thrombolysis) were available for analysis. Overall, 46 (41%) had baseline cerebral microbleeds (15 strictly lobar cerebral microbleeds, 14 mixed cerebral microbleeds, and 17 deep cerebral microbleeds). New cerebral microbleeds only emerged in the intravenous thrombolysis group (seven patients, 11%) within a median of 28.3 h, and did not additionally increase within a median of 7.35 days. In adjusted models, number of cerebral microbleeds (relative risk (RR) 1.30, 95% confidence interval (CI): 1.17-1.44), mixed distribution (RR 19.2, 95% CI: 3.94-93.7), and cerebral microbleeds burden ≥5 (RR 44.9, 95% CI: 5.78-349.8) were associated with new cerebral microbleeds. New cerebral microbleeds were associated with an increase in NIHSS score (p = 0.023). Treatment with alteplase in patients with baseline ≥5 cerebral microbleeds resulted in a numerical shift toward worse outcomes on ordinal mRS (median [IQR]; 4 [3-4] vs. 0 [0-3]), compared with those with <5 cerebral microbleeds (common odds ratio 17.1, 95% CI: 0.76-382.8). The association of baseline ≥5 cerebral microbleeds with ordinal mRS score differed according to the treatment group (p interaction = 0.042). CONCLUSION New cerebral microbleeds developed within 36 h in 11% of the patients after intravenous thrombolysis, and they were significantly associated with mixed-distribution and ≥5 cerebral microbleeds. New cerebral microbleeds development might impede neurological improvement. Furthermore, cerebral microbleeds burden might affect the effect of alteplase.
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Affiliation(s)
- Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Sasaki
- Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.,Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Taizen Nakase
- Department of Stroke Science, Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Shunya Takizawa
- 0Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Koko Asakura
- Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Junya Aoki
- 1Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Haruko Yamamoto
- Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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29
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Cacciottolo M, Morgan TE, Finch CE. Age, sex, and cerebral microbleeds in EFAD Alzheimer disease mice. Neurobiol Aging 2021; 103:42-51. [PMID: 33813349 PMCID: PMC8178216 DOI: 10.1016/j.neurobiolaging.2021.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
Cerebral microbleeds (MBs) increase at later ages in association with increased cognitive decline and Alzheimer Disease (AD). MB prevalence is also increased by APOE4 and hypertension. In EFAD mice (5XFAD+/-/human APOE+/+), cerebral cortex MBs are most prevalent in E4 females at 6 months, paralleling plaque amyloid. We evaluated MBs at 2, 4, and 6 months in relation to amyloid in plaques and cerebral amyloid angiopathy (CAA) by age, sex, APOE allele, and blood pressure. At 2 mo, MBs were 50% more numerous than plaques, followed by decreased ratio of MBs:Aβ plaques with female excess to 6 mo. The stable size of MBs suggests MBs arise as single events of extravasation, which may "seed" plaque formation. Blood pressure was normal from 2 to 6 months, minimizing a role of hypertension. Memory, assessed by fear conditioning, decreased with age in correlation with MBs and amyloid. Cortical layer analysis showed prevalent MBs and plaque in layers 4 and 5. Contrarily, CAA was prevalent in layers 1 and 2, discounting its contribution to MBs.
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Affiliation(s)
- Mafalda Cacciottolo
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Todd E Morgan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Caleb E Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Departments of Neurobiology and Molecular Biology, The Dornsife College, University of Southern California, Los Angeles, CA, USA.
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30
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Mendes A, Noblet V, Mondino M, Loureiro de Sousa P, Manji S, Archenault A, Casanovas M, Bousiges O, Philippi N, Baloglu S, Rauch L, Cretin B, Demuynck C, Martin-Hunyadi C, Blanc F. Association of cerebral microbleeds with cerebrospinal fluid Alzheimer-biomarkers and clinical symptoms in early dementia with Lewy bodies. Int J Geriatr Psychiatry 2021; 36:851-857. [PMID: 33300151 DOI: 10.1002/gps.5485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/11/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the prevalence, localization and associations of cerebral microbleeds (CMB) in dementia with Lewy bodies (DLB) with its core clinical symptoms and cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD). We hypothesize DLB patients with CMB have increased amyloid burden compared to those without CMB, which could also translate into clinical differences. METHODS Retrospective cross-sectional analysis from the AlphaLewyMA study (https://clinicaltrials.gov/ct2/show/NCT01876459). Patients underwent a standardized protocol of brain MRI including 3D T1, 3D FLAIR and T2* sequences, and CSF analysis of AD biomarkers. CMB and white matter hyperintensities (WMHs) were visually assessed in prodromal and mild demented (DLB, N = 91) and AD (AD, N = 67) patients. RESULTS CMB prevalence did not differ among DLB and AD (24.2% vs. 37.3%; p = 0.081). CMB were mainly distributed in lobar topographies in both DLB (74%) and AD (89%). CMB in DLB was not associated with global cognitive performance, executive functioning, speed of information processing, or AD CSF biomarkers. Similarly, there was no difference regarding specific clinical symptoms: fluctuations, psychotic phenomena, sleep behavior disorder and Parkinsonism between DLB patients with and without CMB. AD patients with CMB had increased burden of WMH compared to those without (2.1 ± 0.86 vs. 1.4 ± 0.89; p = 0.005), according to Fazekas scale, whereas no significant difference was observed in DLB patients (1.68 ± 0.95 vs. 1.42 ± 0.91; p = 0.25). CONCLUSION CMB were equally prevalent with similar topographic distribution in both DLB and AD patients. CMB was not associated with CSF AD biomarkers or core clinical symptoms in DLB.
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Affiliation(s)
- Aline Mendes
- Division of Geriatrics and Geneva Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Noblet
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Mary Mondino
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Sumayya Manji
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Anne Archenault
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Michel Casanovas
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Olivier Bousiges
- Laboratoire de Biochimie et Biologie Moléculaire, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR 7364, CNRS, Strasbourg, France.,Neuroradiology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Nathalie Philippi
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Seyyid Baloglu
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR 7364, CNRS, Strasbourg, France
| | - Lucie Rauch
- Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Benjamin Cretin
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Martin-Hunyadi
- Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
| | - Frederic Blanc
- IMIS Team and IRIS Plateform, ICube Laboratory, UMR 7357, French National Centre for Scientific Research (CNRS), Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Memory Resources and Research Centre (CM2R), Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, University Hospital of Strasbourg, Strasbourg, France
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31
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Cerebral microbleeds in vascular dementia from clinical aspects to host-microbial interaction. Neurochem Int 2021; 148:105073. [PMID: 34048844 DOI: 10.1016/j.neuint.2021.105073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 12/30/2022]
Abstract
Vascular dementia is the second leading cause of dementia after Alzheimer's disease in the elderly population worldwide. Cerebral microbleeds (CMBs) are frequently observed in MRI of elderly subjects and considered as a possible surrogate marker. The number and location of CMBs reflect the severity of diseases and the underlying pathologies may involve cerebral amyloid angiopathy or hypertensive vasculopathy. Accumulating evidence demonstrated the clinicopathological discrepancies of CMBs, the clinical significance of CMBs associated with other MRI markers of cerebral small vessel disease, cognitive impairments, serum, and cerebrospinal fluid biomarkers. Moreover, emerging evidence has shown that genetic factors and gene-environmental interactions might shed light on the underlying etiologies of CMBs, focusing on blood-brain-barrier and inflammation. In this review, we introduce recent genetic and microbiome studies as a cutting-edge approach to figure out the etiology of CMBs through the "microbe-brain-oral axis" and "microbiome-brain-gut axis." Finally, we propose novel concepts, "microvascular matrisome" and "imbalanced proteostasis," which may provide better perspectives for elucidating the pathophysiology of CMBs and future development of therapeutics for vascular dementia using CMBs as a surrogate marker.
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32
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Crouzet C, Jeong G, Chae RH, LoPresti KT, Dunn CE, Xie DF, Agu C, Fang C, Nunes ACF, Lau WL, Kim S, Cribbs DH, Fisher M, Choi B. Spectroscopic and deep learning-based approaches to identify and quantify cerebral microhemorrhages. Sci Rep 2021; 11:10725. [PMID: 34021170 PMCID: PMC8140127 DOI: 10.1038/s41598-021-88236-1] [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: 12/24/2020] [Accepted: 03/25/2021] [Indexed: 02/04/2023] Open
Abstract
Cerebral microhemorrhages (CMHs) are associated with cerebrovascular disease, cognitive impairment, and normal aging. One method to study CMHs is to analyze histological sections (5-40 μm) stained with Prussian blue. Currently, users manually and subjectively identify and quantify Prussian blue-stained regions of interest, which is prone to inter-individual variability and can lead to significant delays in data analysis. To improve this labor-intensive process, we developed and compared three digital pathology approaches to identify and quantify CMHs from Prussian blue-stained brain sections: (1) ratiometric analysis of RGB pixel values, (2) phasor analysis of RGB images, and (3) deep learning using a mask region-based convolutional neural network. We applied these approaches to a preclinical mouse model of inflammation-induced CMHs. One-hundred CMHs were imaged using a 20 × objective and RGB color camera. To determine the ground truth, four users independently annotated Prussian blue-labeled CMHs. The deep learning and ratiometric approaches performed better than the phasor analysis approach compared to the ground truth. The deep learning approach had the most precision of the three methods. The ratiometric approach has the most versatility and maintained accuracy, albeit with less precision. Our data suggest that implementing these methods to analyze CMH images can drastically increase the processing speed while maintaining precision and accuracy.
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Affiliation(s)
- Christian Crouzet
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Gwangjin Jeong
- grid.411982.70000 0001 0705 4288Department of Biomedical Engineering, Beckman Laser Institute Korea, Dankook University, Cheonan, 31116 Republic of Korea
| | - Rachel H. Chae
- grid.116068.80000 0001 2341 2786Massachusetts Institute of Technology, Cambridge, MA USA
| | - Krystal T. LoPresti
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Cody E. Dunn
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Danny F. Xie
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA
| | - Chiagoziem Agu
- grid.251990.60000 0000 9562 8554Albany State University, Albany, GA USA
| | - Chuo Fang
- grid.266093.80000 0001 0668 7243Neurology and Pathology and Laboratory Medicine, University of California-Irvine, Irvine, CA USA
| | - Ane C. F. Nunes
- grid.266093.80000 0001 0668 7243Department of Medicine, Division of Nephrology, University of California-Irvine, Irvine, CA USA
| | - Wei Ling Lau
- grid.266093.80000 0001 0668 7243Department of Medicine, Division of Nephrology, University of California-Irvine, Irvine, CA USA
| | - Sehwan Kim
- grid.411982.70000 0001 0705 4288Department of Biomedical Engineering, Beckman Laser Institute Korea, Dankook University, Cheonan, 31116 Republic of Korea
| | - David H. Cribbs
- grid.266093.80000 0001 0668 7243Institute for Memory Impairments and Neurological Disorders, University of California-Irvine, Irvine, CA USA
| | - Mark Fisher
- grid.266093.80000 0001 0668 7243Neurology and Pathology and Laboratory Medicine, University of California-Irvine, Irvine, CA USA
| | - Bernard Choi
- grid.266093.80000 0001 0668 7243Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Biomedical Engineering, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Surgery, University of California-Irvine, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California-Irvine, Irvin, CA USA
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33
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Mike JK, Ferriero DM. Efferocytosis Mediated Modulation of Injury after Neonatal Brain Hypoxia-Ischemia. Cells 2021; 10:1025. [PMID: 33925299 PMCID: PMC8146813 DOI: 10.3390/cells10051025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
Neonatal brain hypoxia-ischemia (HI) is a leading cause of morbidity and long-term disabilities in children. While we have made significant progress in describing HI mechanisms, the limited therapies currently offered for HI treatment in the clinical setting stress the importance of discovering new targetable pathways. Efferocytosis is an immunoregulatory and homeostatic process of clearance of apoptotic cells (AC) and cellular debris, best described in the brain during neurodevelopment. The therapeutic potential of stimulating defective efferocytosis has been recognized in neurodegenerative diseases. In this review, we will explore the involvement of efferocytosis after a stroke and HI as a promising target for new HI therapies.
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Affiliation(s)
- Jana Krystofova Mike
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Donna Marie Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143, USA;
- Department of Neurology Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA
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34
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Rotta J, Perosa V, Yakupov R, Kuijf HJ, Schreiber F, Dobisch L, Oltmer J, Assmann A, Speck O, Heinze HJ, Acosta-Cabronero J, Duzel E, Schreiber S. Detection of Cerebral Microbleeds With Venous Connection at 7-Tesla MRI. Neurology 2021; 96:e2048-e2057. [PMID: 33653897 DOI: 10.1212/wnl.0000000000011790] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Cerebral microbleeds (MBs) are a common finding in patients with cerebral small vessel disease (CSVD) and Alzheimer disease as well as in healthy elderly people, but their pathophysiology remains unclear. To investigate a possible role of veins in the development of MBs, we performed an exploratory study, assessing in vivo presence of MBs with a direct connection to a vein. METHODS 7-Tesla (7T) MRI was conducted and MBs were counted on quantitative susceptibility mapping (QSM). A submillimeter resolution QSM-based venogram allowed identification of MBs with a direct spatial connection to a vein. RESULTS A total of 51 people (mean age [SD] 70.5 [8.6] years, 37% female) participated in the study: 20 had CSVD (cerebral amyloid angiopathy [CAA] with strictly lobar MBs [n = 8], hypertensive arteriopathy [HA] with strictly deep MBs [n = 5], or mixed lobar and deep MBs [n = 7], 72.4 [6.1] years, 30% female) and 31 were healthy controls (69.4 [9.9] years, 42% female). In our cohort, we counted a total of 96 MBs with a venous connection, representing 14% of all detected MBs on 7T QSM. Most venous MBs (86%, n = 83) were observed in lobar locations and all of these were cortical. Patients with CAA showed the highest ratio of venous to total MBs (19%) (HA = 9%, mixed = 18%, controls = 5%). CONCLUSION Our findings establish a link between cerebral MBs and the venous vasculature, pointing towards a possible contribution of veins to CSVD in general and to CAA in particular. Pathologic studies are needed to confirm our observations.
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Affiliation(s)
- Johanna Rotta
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Valentina Perosa
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK.
| | - Renat Yakupov
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Hugo J Kuijf
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Frank Schreiber
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Laura Dobisch
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Jan Oltmer
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Anne Assmann
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Oliver Speck
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Hans-Jochen Heinze
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Julio Acosta-Cabronero
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Emrah Duzel
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Stefanie Schreiber
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
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De Barros A, Arribarat G, Lotterie JA, Dominguez G, Chaynes P, Péran P. Iron distribution in the lentiform nucleus: A post-mortem MRI and histology study. Brain Struct Funct 2021; 226:351-364. [PMID: 33389044 DOI: 10.1007/s00429-020-02175-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Iron plays an important role in many neurobiological processes, especially in the basal ganglia, the brain structures with the highest concentration. Composed of the pallidum and putamen, the lentiform nucleus plays a key role in the basal ganglia circuitry. With MRI advances, iron-based sequences such as R2* and quantitative susceptibility mapping (QSM) are now available for detecting and quantifying iron in different brain structures. Since their validation using classic iron detection techniques (histology or physical techniques), these sequences have attracted growing clinical attention, especially in the field of extrapyramidal syndromes that particularly affect the basal nuclei. Accurate mapping of iron in these nuclei and their connections is needed to gain a better understanding of this specific anatomy, before considering its involvement in the physiopathological processes. We performed R2* and QSM along with Perls histology, to gain new insights into the distribution of iron in the lentiform nucleus and its surrounding structures, based on four specimens obtained from voluntary donors. We found that iron is preferentially distributed in the anterior part of the globus pallidus externus and the posterior part of the putamen. The lateral wall of the putamen is iron-poor, compared with the lateral medullary lamina and intraputaminal fibers. The relevance of perivascular iron concentration, along with pallido- and putaminofugal iron-rich fibers, is discussed.
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Affiliation(s)
- Amaury De Barros
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France. .,Department of Anatomy, Toulouse Faculty of Medicine, Toulouse federal University, Toulouse, France. .,Neuroscience (Neurosurgery) Center, Toulouse University Hospital, Toulouse, France.
| | - Germain Arribarat
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France
| | - Jean Albert Lotterie
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France.,Neuroscience (Neurosurgery) Center, Toulouse University Hospital, Toulouse, France
| | - Gaelle Dominguez
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France.,Neuropathology Unit, University Pathology Laboratory, Toulouse University Hospital-University of Toulouse III-Paul Sabatier, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, Toulouse Faculty of Medicine, Toulouse federal University, Toulouse, France.,Neuroscience (Neurosurgery) Center, Toulouse University Hospital, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France
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Nag S, Chen EY, Johnson R, Tamhane A, Arfanakis K, Schneider JA. Ex vivo MRI facilitates localization of cerebral microbleeds of different ages during neuropathology assessment. FREE NEUROPATHOLOGY 2021; 2:2-35. [PMID: 37284642 PMCID: PMC10209859 DOI: 10.17879/freeneuropathology-2021-3638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/12/2021] [Indexed: 06/08/2023]
Abstract
Cerebral microbleeds (CMBs) identified by in vivo magnetic resonance imaging (MRI) of brains of older persons may have clinical relevance due to their association with cognitive impairment and other adverse neurologic outcomes, but are often not detected in routine neuropathology evaluations. In this study, the utility of ex vivo MRI in the neuropathological identification, localization, and frequency of CMBs was investigated. The study included 3 community dwelling elders with Alzheimer's dementia, and mild to severe small vessel disease (SVD). Ex vivo MRI was performed on the fixed hemisphere to identify CMBs, blinded to the neuropathology diagnoses. The hemibrains were then sliced at 1 cm intervals and 2, 1 or 0 microhemorrhages (MH) were detected on the cut surfaces of brain slabs using the routine neuropathology protocol. Ex vivo imaging detected 15, 14 and 9 possible CMBs in cases 1, 2 and 3, respectively. To obtain histological confirmation of the CMBs detected by ex vivo MRI, the 1 cm brain slabs were dissected further and MHs or areas corresponding to the CMBs detected by ex vivo MRI were blocked and serially sectioned at 6 µm intervals. Macroscopic examination followed by microscopy post ex vivo MRI resulted in detection of 35 MHs and therefore, about 12 times as many MHs were detected compared to routine neuropathology assessment without ex vivo MRI. While microscopy identified previously unrecognized chronic MHs, it also showed that MHs were acute or subacute and therefore may represent perimortem events. Ex vivo MRI detected CMBs not otherwise identified on routine neuropathological examination of brains of older persons and histologic evaluation of the CMBs is necessary to determine the age and clinical relevance of each hemorrhage.
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Affiliation(s)
- Sukriti Nag
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, ILUnited States
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Er-Yun Chen
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Ryan Johnson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Ashish Tamhane
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
| | - Konstantinos Arfanakis
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, ILUnited States
| | - Julie. A Schneider
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, ILUnited States
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, ILUnited States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, ILUnited States
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Fisher M, Lau WL. Of Microbiomes and Microbleeds: A New Piece of the Puzzle? Stroke 2020; 51:3489-3491. [PMID: 33148141 DOI: 10.1161/strokeaha.120.032422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark Fisher
- Department of Neurology (M.F.), UC Irvine School of Medicine, CA
| | - Wei Ling Lau
- Division of Nephrology, Department of Medicine (W.L.L.), UC Irvine School of Medicine, CA
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Tan AP. CAR-T Cell Therapy-Related Neurotoxicity in Pediatric Acute Lymphoblastic Leukemia: Spectrum of Imaging Findings. Pediatr Neurol 2020; 111:51-58. [PMID: 32951662 DOI: 10.1016/j.pediatrneurol.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
The emergence of CD19-targeted chimeric antigen receptor-T (CAR-T) cell therapy has created a new era in the management of pediatric patients with refractory B-cell malignancies such as B-cell acute lymphoblastic leukemia. Immune effector cell-associated neurotoxicity syndrome (ICANS) is frequently encountered in the postinfusion period of CD19-targeted chimeric antigen receptor-T cell therapy and in some cases may be fatal. Knowledge related to the spectrum of imaging findings of CD19-targeted CAR-T cell therapy-related ICANS is, however, still very much lacking, underscoring the need for continued research in this area. In this review, we hope to provide an overview of current knowledge and provide an in-depth literature review related to this topic. A brief discussion of possible imaging differential diagnoses, specifically in children with acute lymphoblastic leukemia, will also be included. Illustrative cases for each imaging phenotype will be provided to facilitate a better understanding. A greater level of insight of the spectrum of imaging findings related to ICANS will improve patients' management and enhance efforts to safely deliver CAR-T cell immunotherapy. It will also facilitate further studies to derive mechanistic insights of ICANS and potentially assist in the testing and monitoring of therapeutic interventions.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Radiology, National University Health System, Singapore.
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Umemura T, Mashita S, Kawamura T. Oral anticoagulant use and the development of new cerebral microbleeds in cardioembolic stroke patients with atrial fibrillation. PLoS One 2020; 15:e0238456. [PMID: 32941455 PMCID: PMC7498025 DOI: 10.1371/journal.pone.0238456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/17/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cerebral microbleeds (CMBs) are a magnetic resonance imaging (MRI) marker for cerebral small vessel disease. Existing CMBs and those that newly develop are associated with the risks of stroke incidence and recurrence. The purpose of the present study was to investigate the association of oral anticoagulant (OAC) use and the development of new CMBs in cardioembolic stroke patients with atrial fibrillation. SUBJECTS AND METHODS We prospectively followed cardioembolic stroke patients with atrial fibrillation who had been hospitalized in the stroke center of our hospital, had been prescribed anticoagulants at discharge, and underwent repeated brain MRI with an interval of at least one year from the baseline MRI. Assessing the presence, number and location of CMBs using T2*-weighted gradient-recalled echo MRI, we used logistic regression models to investigate the associations between OAC use and the incidence of new CMBs. We also examined associations of subsequent stroke with OACs and CMBs during the follow-up. RESULTS A total of 81 patients, consisting of 45 patients receiving direct oral anticoagulants (DOACs) and 36 patients receiving warfarin (WF), were analyzed in the present study. Baseline CMBs were observed in 19/81 patients (23.5%) and new CMBs in 18/81 patients (22.2%) on follow-up MRI (median interval, 34 months). Of the 31 new CMBs, 25 (80.6%) developed in the lobar location and 6 (19.4%) in the deep or infratentorial location. New CMBs occurred in 4 patients (10.0%) taking DOACs alone, in 10 patients (35.7%) taking WF alone, in 3 patients (37.5%) taking WF plus antiplatelet agents and in 1 patient (20.0%) taking DOAC plus antiplatelet agent. Regarding location, the new CMBs were the lobar type in 7 of the 10 patients taking WF alone, as well as in 3 of the 4 patients taking DOACs alone. In multivariate analysis, the presence of CMBs at baseline and WF use (vs. DOAC use) were associated with new CMBs (CMB presence at baseline: OR 4.16, 95% CI 1.19-14.44; WF use: OR 3.38, 95% CI 1.02-11.42). The presence of ≥ 2 CMBs at baseline was related to a higher risk of subsequent stroke (OR 7.25, 95% CI 1.01-52.35, P = 0.048). CONCLUSION Our findings suggest that DOAC compared with WF use at discharge is associated with a lower incidence of new CMBs in cardioembolic stroke patients with atrial fibrillation. Further prospective studies in the clinical setting are needed to confirm our exploratory data.
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Affiliation(s)
- Toshitaka Umemura
- Department of Neurology, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Shinichi Mashita
- Department of Radiology, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety Nagoya, Japan
| | - Takahiko Kawamura
- Department of Diabetes and Endocrine Internal Medicine, Preventive Medical Center, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety Nagoya, Nagoya, Japan
- * E-mail:
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Wadi LC, Grigoryan MM, Kim RC, Fang C, Kim J, Corrada MM, Paganini-Hill A, Fisher MJ. Mechanisms of Cerebral Microbleeds. J Neuropathol Exp Neurol 2020; 42:1093-1099. [PMID: 32930790 DOI: 10.1093/jnen/nlaa082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
Cerebral microbleeds (CMB) are a common MRI finding, representing underlying cerebral microhemorrhages (CMH). The etiology of CMB and microhemorrhages is obscure. We conducted a pathological investigation of CMH, combining standard and immunohistological analyses of postmortem human brains. We analyzed 5 brain regions (middle frontal gyrus, occipital pole, rostral cingulate cortex, caudal cingulate cortex, and basal ganglia) of 76 brain bank subjects (mean age ± SE 90 ± 1.4 years). Prussian blue positivity, used as an index of CMH, was subjected to quantitative analysis for all 5 brain regions. Brains from the top and bottom quartiles (n = 19 each) were compared for quantitative immunohistological findings of smooth muscle actin, claudin-5, and fibrinogen, and for Sclerosis Index (SI) (a measure of arteriolar remodeling). Brains in the top quartile (i.e. with most extensive CMH) had significantly higher SI in the 5 brain regions combined (0.379 ± 0.007 vs 0.355 ± 0.008; p < 0.05). These findings indicate significant coexistence of arteriolar remodeling with CMH. While these findings provide clues to mechanisms of microhemorrhage development, further studies of experimental neuropathology are needed to determine causal relationships.
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Affiliation(s)
- Lara C Wadi
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Mher Mahoney Grigoryan
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Ronald C Kim
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Chuo Fang
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Jeffrey Kim
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - María M Corrada
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Annlia Paganini-Hill
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Mark J Fisher
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
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Griffin AD, Turtzo LC, Parikh GY, Tolpygo A, Lodato Z, Moses AD, Nair G, Perl DP, Edwards NA, Dardzinski BJ, Armstrong RC, Ray-Chaudhury A, Mitra PP, Latour LL. Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury. Brain 2020; 142:3550-3564. [PMID: 31608359 DOI: 10.1093/brain/awz290] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 12/14/2022] Open
Abstract
Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to: (i) identify and characterize traumatic microbleeds in patients with acute traumatic brain injury; (ii) determine whether appearance of traumatic microbleeds predict clinical outcome; and (iii) describe the pathology underlying traumatic microbleeds in an index patient. Patients presenting to the emergency department following acute head trauma who received a head CT were enrolled within 48 h of injury and received a research MRI. Disability was defined using Glasgow Outcome Scale-Extended ≤6 at follow-up. All magnetic resonance images were interpreted prospectively and were used for subsequent analysis of traumatic microbleeds. Lesions on T2* MRI were stratified based on 'linear' streak-like or 'punctate' petechial-appearing traumatic microbleeds. The brain of an enrolled subject imaged acutely was procured following death for evaluation of traumatic microbleeds using MRI targeted pathology methods. Of the 439 patients enrolled over 78 months, 31% (134/439) had evidence of punctate and/or linear traumatic microbleeds on MRI. Severity of injury, mechanism of injury, and CT findings were associated with traumatic microbleeds on MRI. The presence of traumatic microbleeds was an independent predictor of disability (P < 0.05; odds ratio = 2.5). No differences were found between patients with punctate versus linear appearing microbleeds. Post-mortem imaging and histology revealed traumatic microbleed co-localization with iron-laden macrophages, predominately seen in perivascular space. Evidence of axonal injury was not observed in co-localized histopathological sections. Traumatic microbleeds were prevalent in the population studied and predictive of worse outcome. The source of traumatic microbleed signal on MRI appeared to be iron-laden macrophages in the perivascular space tracking a network of injured vessels. While axonal injury in association with traumatic microbleeds cannot be excluded, recognizing traumatic microbleeds as a form of traumatic vascular injury may aid in identifying patients who could benefit from new therapies targeting the injured vasculature and secondary injury to parenchyma.
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Affiliation(s)
- Allison D Griffin
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
| | - L Christine Turtzo
- Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
| | - Gunjan Y Parikh
- R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Zachary Lodato
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Anita D Moses
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Daniel P Perl
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy A Edwards
- Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Bernard J Dardzinski
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Regina C Armstrong
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Abhik Ray-Chaudhury
- Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Partha P Mitra
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Lawrence L Latour
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA.,Acute Cerebrovasular Diagnostics Unit of the National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland, USA
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42
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Chabriat H, Jouvent E. Imaging of the aging brain and development of MRI signal abnormalities. Rev Neurol (Paris) 2020; 176:661-669. [PMID: 32229042 DOI: 10.1016/j.neurol.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
Major changes occur at the cerebral level with aging. Cerebral atrophy develops progressively. Multiple lesions related to small-vessel diseases are detected in association with cerebral atrophy including white-matter hyperintensities, lacunes, microbleeds, dilated perivascular spaces and cerebral, including cortex, atrophy. The clinical impact and predictive value of these Imaging makers were examined.
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Affiliation(s)
- H Chabriat
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France.
| | - E Jouvent
- Inserm U1161 and DHU NeuroVasc, department of neurology, Paris University, Lariboisiere Hospital,Assistance Publique-Hopitaux de Paris, Paris, France
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43
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Zhou YN, Gao HY, Zhao FF, Liang YC, Gao Y, Liu XH, Wang T, Wang ZG, Wu QJ. The study on analysis of risk factors for severity of white matter lesions and its correlation with cerebral microbleeds in the elderly with lacunar infarction. Medicine (Baltimore) 2020; 99:e18865. [PMID: 31977887 PMCID: PMC7004709 DOI: 10.1097/md.0000000000018865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to explore the risk factors for severity of white matter lesions and its correlation with in the elderly with lacunar infarction.Patients (range, 70-85 years) with lacunar infarction treated in a hospital in China from 2016 to 2017were enrolled. Fazekas rating scale (0-6 points) was used to assess severity of white matter lesions. Risk factors for the severity of white matter lesions and correlation between cerebral microbleeds and white matter lesions in the elderly with lacunar infarction were studied.The elderly (81-85 years' old, odds ratio [OR]: 2.423, 95% confidence interval [CI]: 1.795-3.271, P = .018; 76∼80 years' old, OR: 3.113, 95% CI: 1.723-5.625, P = .043), carotid atherosclerosis (OR: 3.062, 95% CI:1.715-5.468, P < .001), history of hypertension (OR: 3.694, 95% CI: 2.031-6.717, P < .001) were risk factors for the severity of white matter lesions. The white matter lesions score increased corresponding to increase in the cerebral microbleeds grade (P < .001). The white matter lesions score was higher in the cerebral microbleeds combined with the white matter lesions group than in the white matter lesions group (P < .01). After correcting the effects of age, there was a correlation between white matter lesions and cerebral microbleeds (P < .001). Logistic analysis revealed that the patients' age (81-85 years' old, OR: 2.722, 95% CI: 1.985-3.734, P = .019; 76∼80 years' old, OR: 1.857, 95% CI: 1.075-3.207, P = .031), history of hypertension (OR: 2.931, 95% CI: 1.136-7.567, P = 0.0.036), systolic blood pressure (OR: 1.049, 95% CI: 1.015-1.084, P = .007), high-sensitivity C-reactive protein (OR: 1.504, 95% CI: 1.254-1.803, P < .001), homocysteine (OR: 1.076, 95% CI: 1.020-1.136, P = .009), and carotid atherosclerosis (OR: 1.389, 95% CI: 1.103-1.748, P = .010) were significant risk factors for combined cerebral microbleeds with white matter lesions in patients with lacunar infarction.The elderly, carotid atherosclerosis, history of hypertension were risk factors for the severity of white matter lesions. Cerebral microbleeds were positively correlated with the severity of white matter lesions.
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Affiliation(s)
- Yu-Ni Zhou
- Department of Neurology, Jining Psychiatric Hospital, Jining
| | - Hao-Yuan Gao
- Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University
| | - Fang-Fang Zhao
- Department of Neurology, Tai’an City Central Hospital, Tai’an
| | - Ying-Chun Liang
- Department of Neurology, Tai’an City Central Hospital, Tai’an
| | - Yuan Gao
- Department of Psychiatry, Jining Psychiatric Hospital, Jining, Shandong
| | - Xin-Hong Liu
- Department of Neurology, Tai’an City Central Hospital, Tai’an
| | - Tao Wang
- Department of Neurology, Tai’an City Central Hospital, Tai’an
| | - Zhi-Gao Wang
- Department of Statistics, East China Normal University, Shanghai
| | - Qing-Jian Wu
- Department of Emergency, Jining NO.1 People's Hospital, Jining, Shandong, China
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44
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Kim BJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kim HY, Kim EG, Kim S, Cha JK, Park MS, Nam HS, Kang DW. Cilostazol Versus Aspirin in Ischemic Stroke Patients With High-Risk Cerebral Hemorrhage: Subgroup Analysis of the PICASSO Trial. Stroke 2019; 51:931-937. [PMID: 31856691 DOI: 10.1161/strokeaha.119.023855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Although cilostazol has shown less hemorrhagic events than aspirin, only marginal difference was observed in hemorrhagic stroke events among patients at high risk for cerebral hemorrhage. To identify patients who would most benefit from cilostazol, this study analyzed interactions between treatment and subgroups of the PICASSO trial (Prevention of Cardiovascular Events in Asian Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage). Methods- Ischemic stroke patients with a previous intracerebral hemorrhage or multiple microbleeds were randomized to treatment with cilostazol or aspirin and followed up for a mean 1.8 years. Efficacy, defined as the composite of any stroke, myocardial infarction, and vascular death, and safety, defined as the incidence of hemorrhagic stroke, were analyzed in the 2 groups. Interactions between treatment and age, sex, presence of hypertension and diabetes mellitus, index of high-risk cerebral hemorrhage, and white matter lesion burden were analyzed for primary and key secondary outcomes. Changes in vital signs and laboratory results were compared in the 2 groups. Results- Among all 1534 patients enrolled, a significant interaction between treatment group and index of high risk for cerebral hemorrhage on hemorrhagic stroke (P for interaction, 0.03) was observed. Hemorrhagic stroke was less frequent in the cilostazol than in the aspirin group in patients with multiple microbleeds (1 versus 13 events; hazard ratio, 0.08 [95% CI, 0.01-0.61]; P=0.01). A marginal interaction between treatment group and white matter change on any stroke (P for interaction, 0.08) was observed. Cilostazol reduced any stroke significantly in patients with mild (5 versus 16 events; hazard ratio, 0.36 [95% CI, 0.13-0.97]; P=0.04)-to-moderate (16 versus 32 events; hazard ratio, 0.50 [95% CI, 0.29-0.92]; P=0.03) white matter changes. Heart rate and HDL (high-density lipoprotein) cholesterol level were significantly higher in the cilostazol group than in the aspirin group at follow-up. Conclusions- Cilostazol may be more beneficial for ischemic stroke patients with multiple cerebral microbleeds and before white matter changes are extensive. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01013532.
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Affiliation(s)
- Bum Joon Kim
- From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)
| | - Sun U Kwon
- Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea
| | - Joung-Ho Park
- Department of Neurology, Hanyang University, Myongji Hospital, Seoul, Korea (J.-H.P.)
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H.)
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong (L.K.S.W.)
| | - Sungwook Yu
- Department of Neurology, Anam Hospital (S.Y.), Korea University, Seoul
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea (Y.-H.H.)
| | - Ji Sung Lee
- Clinical Research Center (J.S.L.), Asan Medical Center, Ulsan University, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics (J.L.), Korea University, Seoul
| | - Jong-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea (J.-H.R.)
| | - Sung Hyuk Heo
- From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Korea (S.H.A.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea (W.-K.S.)
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea (J.-M.P.)
| | - Ju-Hun Lee
- Department of Neurology, Sacred Heart Hospital, Hallym University, Seoul, Korea (J.-H.L.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University, Korea (J.-H.K.)
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea (S.-I.S.)
| | - Jin-Man Jung
- Department of Neurology, Ansan Hospital (J.-M.J.), Korea University, Seoul
| | - Jose C Navarro
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines (J.C.N.)
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (H.Y.K.)
| | - Eung-Gyu Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (E.-G.K.)
| | - Seongheon Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea (S.K.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea (M.-S.P.)
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea (H.S.N.)
| | - Dong-Wha Kang
- Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea
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45
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Michael N, Grigoryan MM, Kilday K, Sumbria RK, Vasilevko V, van Ryn J, Cribbs DH, Paganini-Hill A, Fisher MJ. Effects of Dabigatran in Mouse Models of Aging and Cerebral Amyloid Angiopathy. Front Neurol 2019; 10:966. [PMID: 31611836 PMCID: PMC6776875 DOI: 10.3389/fneur.2019.00966] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/23/2019] [Indexed: 01/11/2023] Open
Abstract
Oral anticoagulants are a critical component of stroke prevention, but carry a risk of brain hemorrhage. These hemorrhagic complications tend to occur in elderly individuals, especially those with predisposing conditions such as cerebral amyloid angiopathy (CAA). Clinical evidence suggests that non-vitamin K antagonist oral anticoagulants are safer than traditional oral anticoagulants. We analyzed whether the anticoagulant dabigatran produces cerebral microhemorrhage (the pathological substrate of MRI-demonstrable cerebral microbleeds) or intracerebral hemorrhage in aged mice with and without hemorrhage-predisposing angiopathy. We studied aged (22 months old) Tg2576 (a model of CAA) and wild-type (WT) littermate mice. Mice received either dabigatran etexilate (DE) (Tg N = 7; WT N = 10) or vehicle (Tg N = 9; WT N = 7) by gavage for 4 weeks. Anticoagulation effects of DE were confirmed using thrombin time assay. No mice experienced intracerebral hemorrhage. Cerebral microhemorrhage analysis, performed using Prussian-blue and H&E staining, showed no significant change in either number or size of cerebral microhemorrhage in DE-treated animals. Analysis of biochemical parameters for endothelial activation (ICAM-1), blood-brain barrier disruption (IgG, claudin-5, fibrinogen), microglial activation (Iba-1), or astrocyte activation (GFAP) showed neither exacerbation nor protective effects of DE in either Tg2576 or WT mice. Our study provides histological and biochemical evidence that aged mice, with or without predisposing factors for brain hemorrhage, tolerate anticoagulation with dabigatran. The absence of dabigatran-induced intracerebral hemorrhage or increased frequency of acute microhemorrhage may provide some reassurance for its use in high-risk patient populations.
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Affiliation(s)
- Neethu Michael
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | | | - Kelley Kilday
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Rachita K Sumbria
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,Department of Biopharmaceutical Sciences, School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, CA, United States
| | - Vitaly Vasilevko
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Joanne van Ryn
- Department of Cardiometabolic Research, Boehringer Ingelheim, Hanover, Germany
| | - David H Cribbs
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Annlia Paganini-Hill
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Mark J Fisher
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, United States.,Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
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46
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Abe T, Takao M, Kimura H, Akaji K, Mihara B, Tanahashi N, Kanda T. Cerebral Microbleeds Detected Using 3.0T Magnetic Resonance Imaging in 2,003 Patients with Ischemic or Hemorrhagic Stroke. JMA J 2019; 2:164-173. [PMID: 33615027 PMCID: PMC7889836 DOI: 10.31662/jmaj.2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction: Compared with 1.5T magnetic resonance imaging (MRI), using 3.0T MRI makes it easier to detect cerebral microbleeds (CMBs). We used 3.0T MRI to investigate the backgrounds, risk factors, and number and location of CMBs in patients with ischemic or hemorrhagic stroke. Methods: We extracted data on clinical characteristics, risk factors, and number and location of CMBs in 2,003 patients treated between January 2010 and December 2014 within one week of stroke occurrence. We then carried out multivariate analysis of the data. Results: CMBs were present in 1,025 patients. The numbers of CMBs in ischemic stroke and hemorrhagic stroke patients were 9,410 and 6,419, respectively. Patients with CMBs showed significantly higher rates of cognitive impairment (p < 0.001, odds ratio [OR] = 1.514), hypertension (p < 0.001, OR = 3.145), previous history of stroke (p < 0.001, OR = 1.782), and presence of hemorrhagic stroke (p < 0.001, OR = 2.066). The use of antithrombotic medication before the stroke did not affect the incidence of CMBs. In ischemic stroke patients, patients with small vessel occlusion had a significantly greater rate of previous history of hemorrhagic stroke (p = 0.046) and number of patients with CMBs (p < 0.001) than those with cardioembolism. Conclusions: CMBs were well observed in patients with small vessel disease, and hypertension was an important factor in ischemic and hemorrhagic stroke. Antithrombotic medication is not associated with the development of CMBs if adequate antihypertensive therapy is provided.
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Affiliation(s)
- Tetsuya Abe
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masaki Takao
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Neurology, Mihara Memorial Hospital, Isesaki, Japan
| | - Hiroaki Kimura
- Department of Neurology, Mihara Memorial Hospital, Isesaki, Japan
| | - Kazunori Akaji
- Department of Neurosurgery, Mihara Memorial Hospital, Isesaki, Japan
| | - Ban Mihara
- Department of Neurology, Mihara Memorial Hospital, Isesaki, Japan
| | - Norio Tanahashi
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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47
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Haller S, Scheffler M, Salomir R, Herrmann FR, Gold G, Montandon ML, Kövari E. MRI detection of cerebral microbleeds: size matters. Neuroradiology 2019; 61:1209-1213. [PMID: 31396662 DOI: 10.1007/s00234-019-02267-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/16/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Cerebral microbleeds (CMB) play an important role as an imaging biomarker notably in vascular and neurodegenerative diseases. Current clinical brain MRI underestimates the number of CMB with respect to histopathology. It is expected that small CMBs are more likely to be false-negatives, yet this has not been demonstrated and the average size of false-negative and true-positive CMBs have not been established. METHODS The radiologic-histopathologic correlation study was approved by the local review board and included 42 consecutive cases (mean age at death, 80.7 ± 10.0 years; 23 females and 19 men) between 12 January 2012 and 10 December 2012 having undergone brain autopsy. Postmortem SWI (susceptibility-weighted imaging) images were acquired on a clinical 3T system using parameters similar to clinical routine. The detection of CMB on postmortem MRI was compared with corresponding histopathological slices. RESULTS Postmortem MRI detected 23 true-positive CMB. Histopathology additionally detected 68 CMBs (false-negative MRI CMBs). The average size true-positive MRI CMBs had on histopathology was 3.6 ± 7.1 mm3. The average size false-negative MRI CMBs was significantly smaller (p < 0.05), measuring 0.3 ± 1.2 mm3 on histopathology. CONCLUSION Size matters. As expected, the average size of true-positive MRI CMB was around 10 times larger as compared with false-negative MRI CMB. Evidently, in addition to size, other factors will influence the detectability of CMB, including iron content, ratio of Fe2+/Fe3+, spatial configuration, and location, yet this remains to be elucidated in future studies.
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Affiliation(s)
- Sven Haller
- Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
| | - Max Scheffler
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Gabriel Gold
- Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Enikö Kövari
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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48
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Chronic Kidney Disease Increases Cerebral Microbleeds in Mouse and Man. Transl Stroke Res 2019; 11:122-134. [PMID: 31055735 PMCID: PMC6957561 DOI: 10.1007/s12975-019-00698-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/28/2019] [Accepted: 02/22/2019] [Indexed: 01/07/2023]
Abstract
Brain microbleeds are increased in chronic kidney disease (CKD) and their presence increases risk of cognitive decline and stroke. We examined the interaction between CKD and brain microhemorrhages (the neuropathological substrate of microbleeds) in mouse and cell culture models and studied progression of microbleed burden on serial brain imaging from humans. Mouse studies: Two CKD models were investigated: adenine-induced tubulointerstitial nephritis and surgical 5/6 nephrectomy. Cell culture studies: bEnd.3 mouse brain endothelial cells were grown to confluence, and monolayer integrity was measured after exposure to 5–15% human uremic serum or increasing concentrations of urea. Human studies: Progression of brain microbleeds was evaluated on serial MRI from control, pre-dialysis CKD, and dialysis patients. Microhemorrhages were increased 2–2.5-fold in mice with CKD independent of higher blood pressure in the 5/6 nephrectomy model. IgG staining was increased in CKD animals, consistent with increased blood–brain barrier permeability. Incubation of bEnd.3 cells with uremic serum or elevated urea produced a dose-dependent drop in trans-endothelial electrical resistance. Elevated urea induced actin cytoskeleton derangements and decreased claudin-5 expression. In human subjects, prevalence of microbleeds was 50% in both CKD cohorts compared with 10% in age-matched controls. More patients in the dialysis cohort had increased microbleeds on follow-up MRI after 1.5 years. CKD disrupts the blood–brain barrier and increases brain microhemorrhages in mice and microbleeds in humans. Elevated urea alters the actin cytoskeleton and tight junction proteins in cultured endothelial cells, suggesting that these mechanisms explain (at least in part) the microhemorrhages and microbleeds observed in the animal and human studies.
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49
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Chen YC, Wei XE, Lu J, Qiao RH, Shen XF, Li YH. Correlation Between Intracranial Arterial Calcification and Imaging of Cerebral Small Vessel Disease. Front Neurol 2019; 10:426. [PMID: 31118918 PMCID: PMC6506782 DOI: 10.3389/fneur.2019.00426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: Vascular calcification is part of the atherosclerotic process. Intracranial artery calcification is closely associated with cerebral small vessel disease (SVD). The present study aimed to investigate the distribution pattern of intracranial arterial calcification and its association with magnetic resonance imaging (MRI) markers of SVD in patients with acute ischemic cerebrovascular disease. Methods: Two hundred and seventy six consecutive patients with transient ischemic attack (TIA) or acute ischemic stroke who underwent both computed tomography (CT) angiography and MRI were enrolled in this study. Intracranial arterial calcium scores were evaluated using Agatston method. MRI was performed to assess cerebral infarction, white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs). Results: Intracranial artery calcification was present in 200 (72.46%) patients, with the highest prevalence in the internal carotid arteries (ICA) (64.8%). The severity of intracranial arterial calcification was associated with the presence of WMHs (P = 0.0001), lacunes (P = 0.0001), and CMBs (P = 0.0001); however, there was no association between calcifications and the presence of EPVSs (P = 0.058). The correlation coefficients (rs) were 0.350, 0.142, 0.285, and 0.251 for WMHs, EPVSs, lacunes, and CMBs, respectively. The adjusted odds ratios (ORs) of intracranial arterial calcification were: 2.747 for WMH (grade 1-2), 3.422 for WMH (grade 3), 2.902 for lacunes, 2.449 for CMB, 0.88 for EPVS (grade 1), and 0.295 for EPVS (grade 2-4). Conclusion: Intracranial artery calcification is common in patients with ischemic cerebrovascular disease and the intracranial carotid artery is most frequently affected. Intracranial arterial calcifications might be associated with imaging markers of SVD and are highly correlated with WMHs, lacunes, and CMBs. Quantification of calcification on CT provides additional information on the pathophysiology of SVD. Intracranial arterial calcification could act as a potential marker of SVD.
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Affiliation(s)
- Yuan-Chang Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui-Hua Qiao
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xue-Feng Shen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Zhang R, Li Q, Zhou Y, Yan S, Zhang M, Lou M. The relationship between deep medullary veins score and the severity and distribution of intracranial microbleeds. NEUROIMAGE-CLINICAL 2019; 23:101830. [PMID: 31039526 PMCID: PMC6529678 DOI: 10.1016/j.nicl.2019.101830] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/07/2019] [Accepted: 04/17/2019] [Indexed: 01/06/2023]
Abstract
Background Microbleeds are frequently detected in normal elderly population, and their presence is associated with an increased risk of intracerebral hemorrhage, ischemic stroke and cognitive impairment. Previous histopathologic findings mainly focused on arteries and capillaries. Nevertheless, few studies investigated the relationship between venous disruption and microbleeds. Objective We aimed to evaluate the extent of venous disruption in vivo and assess the correlation between deep medullary veins (DMVs) disruption and the severity and distribution of intracranial microbleeds in patients with cerebral small vessel disease (cSVD). Methods We retrospectively reviewed the clinical, laboratory and imaging data of the patients admitted to our department who received brain MRI and presented with CSVD imaging markers. Susceptibility weighted imaging (SWI) phase images were used to observe characteristics of DMVs and derive a brain region-based DMVs visual score. SWI magnitude images were used to evaluate microbleeds. We recorded the number and distribution (lobar or deep or infratentorial) of microbleeds. One-way ANOVA and logistic-regression analysis were used to examine the association between the DMVs score and microbleeds. Results A total of 369 cSVD patients were analyzed, including 177 (48.0%) patients with microbleeds, among whom 81(45.8%) patients had 1–2 microbleeds and 96 (54.2%) patients had ≥3 microbleeds (extensive microbleeds). The patients' DMVs score ranged from 0 to18, with a median score of 8(6–12). Higher DMVs score was independently associated with extensive microbleeds (OR = 1.108, 95%Cl: 1.010–1.215, p = 0.03) after adjusting for gender, hypertension, hyperhomocysteinemia, Fazekas score and number of lacunas. According to the distribution, 38 (21.5%) patients were found with strict lobar microbleeds, while 139 (78.5%) patients had non-strict lobar microbleeds. Higher DMVs score was also independently associated with non-strict lobar microbleeds (OR = 1.106, 95% Cl: 1.019–1.200, p = 0.016) after adjusting for gender, hypertension, hyperhomocysteinemia, Fazekas score and number of lacunas. DMVs score was not associated with strict lobar microbleeds (p = 0.307). Conclusion DMVs disruption might be involved in the development of extensive microbleeds, especially non-strict lobar cerebral microbleeds. Deep medullary veins disruption was associated with extensive microbleeds. Deep medullary veins disruption was associated with non-strict lobar microbleeds. Venous insufficiency may be one of the pathogenic mechanisms of microbleeds.
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Affiliation(s)
- Ruiting Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, China
| | - Qingqing Li
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88# Jiefang Road, Hangzhou, China.
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