1
|
Turner N, Farrow B, Betrie AH, Finnis ME, Lankadeva YR, Sharman J, Tan P, Abdelhamid YA, Deane AM, Plummer MP. Cerebrospinal fluid and plasma ascorbate concentrations following subarachnoid haemorrhage. CRIT CARE RESUSC 2023; 25:175-181. [PMID: 38234324 PMCID: PMC10790009 DOI: 10.1016/j.ccrj.2023.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 01/19/2024]
Abstract
Background Ascorbate, the biologically active form of vitamin C, is the primary neural anti-oxidant. Ascorbate concentrations have never been quantified following aneurysmal subarachnoid haemorrhage (aSAH). Objective To quantify plasma and cerebrospinal fluid (CSF) ascorbate concentrations in patients following SAH. Design Setting Participants Main Outcome Measures Cohort study in which plasma and CSF ascorbate concentrations were measured longitudinally in 12 aSAH patients admitted to a quaternary referral intensive care unit and compared to one-off samples obtained from 20 pregnant women prior to delivery in a co-located obstetric hospital. Data are median [interquartile range] or median (95 % confidence intervals). Results Forty-eight plasma samples were obtained from the 12 aSAH patients (eight females, age 62 [53-68] years). Eight participants with extra-ventricular drains provided 31 paired CSF-plasma samples. Single plasma and CSF samples were obtained from 20 pregnant women (age 35 [31-37] years). Initial plasma and CSF ascorbate concentrations post aSAH were less than half those in pregnant controls (plasma: aSAH: 31 [25-39] μmol/L vs. comparator: 64 [59-77] μmol/L; P < 0.001 and CSF: 116 [80-142] μmol/L vs. 252 [240-288] μmol/L; P < 0.001). Post aSAH there was a gradual reduction in the CSF:plasma ascorbate ratio from ∼4:1 to ∼1:1. Six (50 %) patients developed vasospasm and CSF ascorbate concentrations were lower in these patients (vasospasm: 61 (25, 97) vs. no vasospasm: 110 (96, 125) μmol/L; P = 0.01). Conclusion Post aSAH there is a marked reduction in CSF ascorbate concentration that is most prominent in those who develop vasospasm.
Collapse
Affiliation(s)
- Natasha Turner
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Brodie Farrow
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Ashenafi H. Betrie
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria 3052, Australia
- Translational Neurodegeneration Laboratory, Florey Institute of Neuroscience and Mental Health, Health, Melbourne, Victoria 3052, Australia
| | - Mark E. Finnis
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3010, Australia
- Intensive Care Unit Research, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Yugeesh R. Lankadeva
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria 3052, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Jeremy Sharman
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Patrick Tan
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3010, Australia
- Department of Anaesthesia, The Royal Women's Hospital, Grattan Street & Flemington Road, Melbourne, Victoria 3052, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Adam M. Deane
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Mark P. Plummer
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3010, Australia
- Intensive Care Unit Research, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| |
Collapse
|
2
|
Solár P, Zamani A, Lakatosová K, Joukal M. The blood-brain barrier and the neurovascular unit in subarachnoid hemorrhage: molecular events and potential treatments. Fluids Barriers CNS 2022; 19:29. [PMID: 35410231 PMCID: PMC8996682 DOI: 10.1186/s12987-022-00312-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
The response of the blood-brain barrier (BBB) following a stroke, including subarachnoid hemorrhage (SAH), has been studied extensively. The main components of this reaction are endothelial cells, pericytes, and astrocytes that affect microglia, neurons, and vascular smooth muscle cells. SAH induces alterations in individual BBB cells, leading to brain homeostasis disruption. Recent experiments have uncovered many pathophysiological cascades affecting the BBB following SAH. Targeting some of these pathways is important for restoring brain function following SAH. BBB injury occurs immediately after SAH and has long-lasting consequences, but most changes in the pathophysiological cascades occur in the first few days following SAH. These changes determine the development of early brain injury as well as delayed cerebral ischemia. SAH-induced neuroprotection also plays an important role and weakens the negative impact of SAH. Supporting some of these beneficial cascades while attenuating the major pathophysiological pathways might be decisive in inhibiting the negative impact of bleeding in the subarachnoid space. In this review, we attempt a comprehensive overview of the current knowledge on the molecular and cellular changes in the BBB following SAH and their possible modulation by various drugs and substances.
Collapse
Affiliation(s)
- Peter Solár
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic
| | - Alemeh Zamani
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic
| | - Klaudia Lakatosová
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic
| | - Marek Joukal
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic.
| |
Collapse
|
3
|
Kangisser L, Tan E, Bellomo R, Deane AM, Plummer MP. Neuroprotective Properties of Vitamin C: A Scoping Review of Pre-Clinical and Clinical Studies. J Neurotrauma 2021; 38:2194-2205. [PMID: 33544035 DOI: 10.1089/neu.2020.7443] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
There is a need for novel neuroprotective therapies. We aimed to review the evidence for exogenous vitamin C as a neuroprotective agent. MEDLINE, Embase, and Cochrane library databases were searched from inception to May 2020. Pre-clinical and clinical reports evaluating vitamin C for acute neurological injury were included. Twenty-two pre-clinical and 11 clinical studies were eligible for inclusion. Pre-clinical studies included models of traumatic and hypoxic brain injury, subarachnoid and intracerebral hemorrhage, and ischemic stroke. The median [IQR] maximum daily dose of vitamin C in animal studies was 120 [50-500] mg/kg. Twenty-one animal studies reported improvements in biomarkers, functional outcome, or both. Clinical studies included single reports in neonatal hypoxic encephalopathy, traumatic brain injury, and subarachnoid hemorrhage and eight studies in ischemic stroke. The median maximum daily dose of vitamin C was 750 [500-1000] mg, or ∼10 mg/kg for an average-size adult male. Apart from one case series of intracisternal vitamin C administration in subarachnoid hemorrhage, clinical studies reported no patient-centered benefit. Although pre-clinical trials suggest that exogenous vitamin C improves biomarkers of neuroprotection, functional outcome, and mortality, these results have not translated to humans. However, clinical trials used approximately one tenth of the vitamin C dose of animal studies.
Collapse
Affiliation(s)
- Lauren Kangisser
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Elinor Tan
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam M Deane
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark P Plummer
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Kikkawa Y, Kurogi R, Sasaki T. The single and double blood injection rabbit subarachnoid hemorrhage model. Transl Stroke Res 2014; 6:88-97. [PMID: 25381219 DOI: 10.1007/s12975-014-0375-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/25/2014] [Accepted: 10/22/2014] [Indexed: 12/27/2022]
Abstract
Over the past 30 years, the rabbit subarachnoid hemorrhage model (SAH) has been used for investigating the post-hemorrhage pathology, especially with respect to understanding of the mechanisms of cerebral vasospasm. However, the molecular mechanisms of cerebral vasospasm remain to be elucidated. Furthermore, it is not clear whether the rabbit SAH model is suitable for the investigation of pathological conditions other than cerebral vasospasm, such as early brain injury. Therefore, the properties of the rabbit SAH model need to be validated, and the reasons for using the rabbit should be clarified. This review explores the settings and technical issues of establishing a rabbit cisterna magna single and double blood injection SAH model and discusses the characteristics and feasibilities of the models.
Collapse
Affiliation(s)
- Yuichiro Kikkawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
| | | | | |
Collapse
|