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Wu C, Liu H, Zuo Q, Jiang A, Wang C, Lv N, Lin R, Wang Y, Zong K, Wei Y, Huang Q, Li Q, Yang P, Zhao R, Liu J. Identifying novel risk genes in intracranial aneurysm by integrating human proteomes and genetics. Brain 2024; 147:awae111. [PMID: 39084678 DOI: 10.1093/brain/awae111] [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: 07/19/2023] [Revised: 03/01/2024] [Accepted: 03/09/2024] [Indexed: 08/02/2024] Open
Abstract
Genome-wide association studies (GWAS) have become increasingly popular for detecting numerous loci associated with intracranial aneurysm (IA), but how these loci function remains unclear. In this study, we employed an integrative analytical pipeline to efficiently transform genetic associations and identify novel genes for IA. Using multidimensional high-throughput data, we integrated proteome-wide association studies (PWAS), transcriptome-wide association studies (TWAS), Mendelian randomization (MR) and Bayesian co-localization analyses to prioritize genes that can increase IA risk by altering their expression and protein abundances in the brain and blood. Moreover, single-cell RNA sequencing (scRNA-seq) of the circle of Willis was performed to enrich filtered genes in cells, and gene set enrichment analysis (GSEA) was conducted for each gene using bulk RNA-seq data for IA. No significant genes with cis-regulated plasma protein levels were proven to be associated with IA. The protein abundances of five genes in the brain were found to be associated with IA. According to cellular enrichment analysis, these five genes were expressed mainly in the endothelium, fibroblasts and vascular smooth muscle cells. Only three genes, CNNM2, GPRIN3 and UFL1, passed MR and Bayesian co-localization analyses. While UFL1 was not validated in confirmation PWAS as it was not profiled, it was validated in TWAS. GSEA suggested these three genes are associated with the cell cycle. In addition, the protein abundance of CNNM2 was found to be associated with IA rupture (based on PWAS, MR and co-localization analyses). Our findings indicated that CNNM2, GPRIN3 and UFL1 (CNNM2 correlated with IA rupture) are potential IA risk genes that may provide a broad hint for future research on possible mechanisms and therapeutic targets for IA.
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Affiliation(s)
- Congyan Wu
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Hanchen Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Qiao Zuo
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Aimin Jiang
- Department of Urology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Chuanchuan Wang
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Nan Lv
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Ruyue Lin
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Yonghui Wang
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Kang Zong
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Yanpeng Wei
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Qiang Li
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
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Zhou H, Song Y, Wang C, Zhu Q, Feng Y. Identification of differentially expressed autophagy-related genes in cases of intracranial aneurysm: Bioinformatics analysis. J Stroke Cerebrovasc Dis 2024; 33:107687. [PMID: 38521147 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107687] [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: 11/23/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Recent research indicates that autophagy is essential for the rupture of intracranial aneurysm (IA). This study aimed to examine and validate potential autophagy-related genes (ARGs) in cases of IA using bioinformatics analysis. METHODS Two expression profiles (GSE54083 and GSE75436) were obtained from the Gene Expression Omnibus database. Differentially expressed ARGs (DEARGs) in cases of IA were screened using GSE75436, and enrichment analysis and Protein-Protein Interaction (PPI) networks were used to identify the hub genes and related pathways. Furthermore, a novel predictive diagnostic signature for IA based on the hub genes was constructed. The area under the Receiver Operating Characteristic curve (AUC) was used to evaluate the signature performance in GSE75436. RESULTS In total, 75 co-expressed DEARGs were identified in the GSE75436 and GSE54083 dataset (28 upregulated and 47 downregulated genes). Enrichment analysis of DEARGs revealed several enriched terms associated with proteoglycans in cancer and human immunodeficiency virus 1 infection. PPI analysis revealed interactions between these genes. Hub DEARGs included insulin-like growth factor 1, clusters of differentiation 4, cysteine-aspartic acid protease 8, Bcl-2-like protein 11, mouse double mutant 2 homolog, toll-like receptor 4, growth factor receptor-bound protein 2, Jun proto-oncogene, AP-1 transcription factor subunit, hypoxia inducible factor 1 alpha, and erythroblastic oncogene B-2. Notably, the signature showed good performance in distinguishing IA (AUC = 0.87). The sig calibration curves showed good calibration. CONCLUSION Bioinformatic analysis identified 75 potential DEARGs in cases of IA. This study revealed that IA is affected by autophagy, which could explain the pathogenesis of IA and aid in its diagnosis and treatment. However, future research with experimental validation is necessary to identify potential DEARGs in cases of IA.
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Affiliation(s)
- Han Zhou
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao, Shandong 266000, China
| | - Yancheng Song
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510000, China; Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong 266000, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao, Shandong 266000, China
| | - Quanzhou Zhu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao, Shandong 266000, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao, Shandong 266000, China.
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3
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Yan K, Bian J, He L, Song B, Shen L, Zhen Y. Effects of KLF11 on Vascular Smooth Muscle Cells and its Underlying Mechanisms in Intracranial Aneurysm. Biochem Genet 2024:10.1007/s10528-024-10681-0. [PMID: 38368567 DOI: 10.1007/s10528-024-10681-0] [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: 09/25/2023] [Accepted: 01/02/2024] [Indexed: 02/19/2024]
Abstract
Vascular smooth muscle cells (VSMCs) affect the phenotypic changes in intracranial aneurysm (IA). They exhibit enhanced dissociation and migration and play a key role in IA pathogenesis. KLF transcription factor 11 (KLF11), a member of the KLF family, significantly affects the cancer cell proliferation, differentiation, and apoptosis. However, its expression, biological functions, and latent action mechanisms in IA remain unclear. This study aimed to analyze the effects of KLF11 on H2O2-induced human brain VSMCs (HBVSMCs) in IA. We determined the mRNA levels of KLF11 in 15 paired arterial wall tissues of patients with IA and healthy volunteers. HBVSMCs were stimulated with H2O2 for 6 h to establish an IA model in vitro. Cell viability, apoptosis, and inflammatory cytokine (interleukin [IL-1β, tumor necrosis factor-α, and IL-6) levels were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2-5-diphenyltetrazolium bromide, flow cytometry, and enzyme-linked immunosorbent assays, respectively. KLF11 expression was determined via quantitative reverse transcription-polymerase chain reaction, western blotting, and immunofluorescence analyses. Furthermore, p-p38, p38, cleaved-caspase 3, and caspase 3 levels were determined via western blotting. KLF11 levels were downregulated in the arterial wall tissues of patients with IA than in those of the control group. KLF11 upregulation by KLF11-plasmid promoted the cell viability, reduced apoptosis, decreased cleaved-caspase 3 expression, and inhibited the secretion of inflammatory factors in H2O2-induced HBVSMCs. KLF11-plasmid remarkably reduced p-p38 expression and p-p38/p-38 ratio; however, these effects were reversed by P79350 treatment. Overall, KLF11 upregulation improved the HBVSMC functions and exerted protective effects against IA, suggesting its potential for IA treatment.
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Affiliation(s)
- Ke Yan
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Jiarong Bian
- Department of Respiratory Medicine, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Liang He
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Bingwei Song
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Linhai Shen
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, China
| | - Yong Zhen
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, China.
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4
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MacDonald DE, Cancelliere NM, Rustici A, Pereira VM, Steinman DA. Improving visualization of three-dimensional aneurysm features via segmentation with upsampled resolution and gradient enhancement (SURGE). J Neurointerv Surg 2022:neurintsurg-2022-018912. [PMID: 35728943 DOI: 10.1136/neurintsurg-2022-018912] [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: 03/16/2022] [Accepted: 06/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intracranial aneurysm neck width tends to be overestimated when measured with three-dimensional rotational angiography (3DRA) compared with two-dimensional digital subtraction angiography (2D-DSA), owing to high curvature at the neck. This may affect morphological and hemodynamic analysis in support of treatment planning. We present and validate a method for extracting high curvature features, such as aneurysm ostia, during segmentation of 3DRA images. METHODS In our novel SURGE (segmentation with upsampled resolution and gradient enhancement) approach, the gradient of an upsampled image is sharpened before gradient-based watershed segmentation. Neck measurements were performed for both standard and SURGE segmentations of 3DRA for 60 consecutive patients and compared with those from 2D-DSA. Those segmentations were also qualitatively compared for surface topology and morphology. RESULTS Compared with the standard watershed method, SURGE reduced neck measurement error relative to 2D-DSA by >60%: median error was 0.49 mm versus 0.17 mm for SURGE, which is less than the average pixel resolution (~0.33 mm) of the 3DRA dataset. SURGE reduced neck width overestimations >1 mm from 13/60 to 5/60 cases. Relative to 2D-DSA, standard segmentations were overestimated by 16% and 93% at median and 95th percentiles, respectively, compared with only 6% and 37%, respectively, for SURGE. CONCLUSION SURGE provides operators with high-level control of the image gradient, allowing recovery of high-curvature features such as aneurysm ostia from 3DRA where conventional algorithms may fail. Compared with standard segmentation and tedious manual editing, SURGE provides a faster, easier, and more objective method for assessing aneurysm ostia and morphology.
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Affiliation(s)
- Daniel E MacDonald
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Arianna Rustici
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.,Departments of Medical Imaging and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David A Steinman
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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5
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Zhu H, Hao Z, Xing Z, Tan J, Zhao Y, Li M. Impinging Flow Induces Expression of Monocyte Chemoattractant Protein-1 in Endothelial Cells Through Activation of the c-Jun N-terminal Kinase/c-Jun/p38/c-Fos Pathway. World Neurosurg 2022; 164:e681-e693. [PMID: 35580782 DOI: 10.1016/j.wneu.2022.05.032] [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: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Monocyte chemoattractant protein-1 (MCP-1) is an important regulator of the formation and development of intracranial aneurysms. This study explored the molecular mechanisms underlying the induction of MCP-1 and related inflammatory factors in human umbilical vein endothelial cells (HUVECs) under hemodynamic conditions. METHODS A modified T chamber was used to simulate fluid flow at the bifurcation of the artery and wall shear stress on HUVECs in vitro. Changes in HUVECs were analyzed in response to impinging flow. And HUVECs without impinging flow were used as the control group. Protein expression levels of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38, activator protein-1, and MCP-1 were detected by Western blot, and the messenger RNA expression levels of MCP-1, interleukin (IL)-1β, and IL-6 were determined by quantitative reverse transcription polymerase chain reaction. RESULTS Under impinging flow, the phosphorylation levels of ERK, JNK, and p38, as well as the protein levels of MCP-1, c-Jun, and c-Fos, increased. The messenger RNA expression of MCP-1, IL-1β, and IL-6 also increased in HUVECs. Pretreatment of the HUVECs with inhibitors of JNK and p38 significantly attenuated the increased expression of MCP-1, IL-1β, and IL-6, while ERK inhibitors had no obvious effect. CONCLUSIONS Under impinging flow, MCP-1 and inflammatory factors are regulated through the JNK/c-Jun/p38/c-Fos pathway and participate in EC inflammation.
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Affiliation(s)
- Huaxin Zhu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zheng Hao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; Trauma Center, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zelong Xing
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; Department of Neurosurgery, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, China
| | - Jiacong Tan
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yeyu Zhao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Meihua Li
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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6
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Morel S, Bijlenga P, Kwak BR. Intracranial aneurysm wall (in)stability-current state of knowledge and clinical perspectives. Neurosurg Rev 2021; 45:1233-1253. [PMID: 34743248 PMCID: PMC8976821 DOI: 10.1007/s10143-021-01672-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
Intracranial aneurysm (IA), a local outpouching of cerebral arteries, is present in 3 to 5% of the population. Once formed, an IA can remain stable, grow, or rupture. Determining the evolution of IAs is almost impossible. Rupture of an IA leads to subarachnoid hemorrhage and affects mostly young people with heavy consequences in terms of death, disabilities, and socioeconomic burden. Even if the large majority of IAs will never rupture, it is critical to determine which IA might be at risk of rupture. IA (in)stability is dependent on the composition of its wall and on its ability to repair. The biology of the IA wall is complex and not completely understood. Nowadays, the risk of rupture of an IA is estimated in clinics by using scores based on the characteristics of the IA itself and on the anamnesis of the patient. Classification and prediction using these scores are not satisfying and decisions whether a patient should be observed or treated need to be better informed by more reliable biomarkers. In the present review, the effects of known risk factors for rupture, as well as the effects of biomechanical forces on the IA wall composition, will be summarized. Moreover, recent advances in high-resolution vessel wall magnetic resonance imaging, which are promising tools to discriminate between stable and unstable IAs, will be described. Common data elements recently defined to improve IA disease knowledge and disease management will be presented. Finally, recent findings in genetics will be introduced and future directions in the field of IA will be exposed.
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Affiliation(s)
- Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland. .,Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
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Differentially Expressed Circular RNA Profile in an Intracranial Aneurysm Group Compared with a Healthy Control Group. DISEASE MARKERS 2021; 2021:8889569. [PMID: 33574968 PMCID: PMC7864737 DOI: 10.1155/2021/8889569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/12/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022]
Abstract
Objective Intracranial aneurysm (IA) is a fatal disease owing to vascular rupture and subarachnoid hemorrhage. Much attention has been given to circular RNAs (circRNAs) because they may be potential biomarkers for many diseases, but their mechanism in the formation of IA remains unknown. Methods circRNA expression profile analysis of blood samples was conducted between patients with IA and controls. Overall, 235 differentially expressed circRNAs were confirmed between IA patients and the control group. The reliability of the microarray results was demonstrated by quantitative real-time polymerase chain reaction (qRT-PCR). Results Of 235 differentially expressed genes, 150 were upregulated, while the other 85 were downregulated. Five miRNAs matched to every differential expression of circRNAs, and related MREs were predicted. We performed gene ontology (GO) analysis to identify the functions of their targeted genes, with the terms “Homophilic cell adhesion via plasma membrane adhesion molecules” and “Positive regulation of cellular process” showing the highest fold enrichment. Conclusions This study demonstrated the role of circRNA expression profiling in the formation of IA and revealed that the mTOR pathway can be a latent therapeutic strategy for IA.
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8
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ZHANG J, JIN J, YANG W. [Autophagy regulates the function of vascular smooth muscle cells in the formation and rupture of intracranial aneurysms]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:552-559. [PMID: 31901031 PMCID: PMC8800671 DOI: 10.3785/j.issn.1008-9292.2019.10.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/24/2019] [Indexed: 06/10/2023]
Abstract
Vascular smooth muscle cells (VSMC) are the main cellular component of vessel wall. The changes of VSMC functions including phenotypic transformation and apoptosis play a critical role in the pathogenesis of intracranial aneurysm (IA). Autophagy can participate in the regulation of vascular function by regulating cell function. In the initial stage of IA, the activation of autophagy can accelerate the phenotypic transformation of VSMC and inhibit VSMC apoptosis. With the progress of IA, the relationship between autophagy and apoptosis changes from antagonism to synergy or promotion, and a large number of apoptotic VSMC lead to the rupture of IA. In this review, we describe the role of autophagy regulating the function of VSMC in the occurrence, development and rupture of IA, for further understanding the pathogenesis of IA and finding molecular targets to prevent the formation and rupture of IA.
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Affiliation(s)
| | | | - Wei YANG
- 杨巍(1976-), 男, 博士, 教授, 博士生导师, 主要从事神经生物学及药理学研究; E-mail:
;
https://orcid.org/0000-0003-3065-1843
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9
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Wang Y, Wang C, Yang Q, Cheng YL. ANXA3 Silencing Ameliorates Intracranial Aneurysm via Inhibition of the JNK Signaling Pathway. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 17:540-550. [PMID: 31362241 PMCID: PMC6661453 DOI: 10.1016/j.omtn.2019.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 01/10/2023]
Abstract
Intracranial aneurysm (IA) rupture is a major cause of stroke death. Alteration of vascular smooth muscle cell (VSMC) function and phenotypic modulation plays a role in aneurysm progression. In the present study, we investigated the role of Annexin A3 (ANXA3) silencing in IA with the interaction of the c-Jun N-terminal kinase (JNK) signaling pathway. In IA and VSMCs of IA, the relationship between ANXA3 and the JNK signaling pathway was verified. To investigate the specific mechanism of ANXA3 silencing in IA, we transfected VSMCs with the overexpressed or small interfering RNA (siRNA) of ANXA3, or treated them with an inhibitor of the JNK signaling (SP600125). Cell counting kit-8 (CCK-8) assay was conducted to detect cell viability, and flow cytometry was conducted to assess cell cycle and apoptosis so as to evaluate the gain- and loss-of-function of ANXA3 and investigate the involvement of the JNK signaling pathway. The aneurysm wall of IA cells demonstrated an elevated level of ANXA3 expression and an activated JNK signaling pathway. VSMCs treated with siRNA-ANXA3 or SP600125 showed decreased expression of JNK, caspase-3, osteopontin (OPN), Bax, and matrix metalloproteinase-9 (MMP-9), as well as phosphate (p)-JNK, but increased the expression of α smooth muscle actin (α-SMA), β-tubulin, and Bcl-2. ANXA3 silencing or inactivation of the JNK signaling pathway also enhanced proliferation and repressed apoptosis of VSMCs. Collectively, this study shows that the silencing of ANXA3 can rescue VSMC function in IAs by inhibiting the phosphorylation and activation of the JNK signaling pathway. These findings may provide a potential therapy for the molecular treatment of IAs.
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Affiliation(s)
- Yang Wang
- Department of Neurosurgery (2nd Ward), Taihe Hospital, Shiyan 442000, P.R. China.
| | - Chun Wang
- Department of Neurosurgery, Suizhou Central Hospital, Suizhou 441300, P.R. China
| | - Qi Yang
- Department of Orthopaedic Surgery (3rd Ward), Taihe Hospital, Shiyan 442000, P.R. China
| | - Yan-Li Cheng
- Department of Dermatology, Taihe Hospital, Shiyan 442000, P.R. China
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10
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Leemans EL, Cornelissen BMW, Rosalini G, Verbaan D, Schneiders JJ, van den Berg R, Vandertop WP, van Bavel ET, Slump CH, Majoie CBLM, Marquering HA. Impact of Intracranial Aneurysm Morphology and Rupture Status on the Particle Residence Time. J Neuroimaging 2019; 29:487-492. [PMID: 31002750 PMCID: PMC6618041 DOI: 10.1111/jon.12618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Aneurysm hemodynamics play an important role in aneurysm growth and subsequent rupture. Within the available hemodynamic characteristics, particle residence time (PRT) is relatively unexplored. However, some studies have shown that PRT is related to thrombus formation and inflammation. The goal of this study is to evaluate the association between PRT and aneurysm rupture and morphology. METHODS We determined the PRT for 113 aneurysms (61 unruptured, 53 ruptured) based on computational fluid dynamic models. Virtual particles were injected into the parent vessel and followed during multiple cardiac cycles. PRT was defined as the time needed for 99% of the particles that entered an aneurysm to leave the aneurysm. Subsequently, we evaluated the association between PRT, rupture, and morphology (aneurysm type, presence of blebs, or multiple lobulations). RESULTS PRT showed no significant difference between unruptured (1.1 seconds interquartile range [IQR .39-2.0 seconds]) and ruptured aneurysms (1.2 seconds [IQR .47-2.3 seconds]). PRT was influenced by aneurysm morphology. Longer PRTs were seen in bifurcation aneurysms (1.3 seconds [IQR .54-2.4 seconds], P = .01) and aneurysms with blebs or multiple lobulations (1.92 seconds [IQR .94-2.8 seconds], P < .001). Four of five partially thrombosed aneurysms had a long residence time (>1.9 seconds). CONCLUSIONS Our study shows an influence of aneurysm morphology on PRT. Nevertheless, it suggests that PRT cannot be used to differentiate unruptured and ruptured aneurysms.
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Affiliation(s)
- E L Leemans
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B M W Cornelissen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - G Rosalini
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Industrial Engineering and Information, University of Pavia, Pavia, Italy
| | - D Verbaan
- Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J J Schneiders
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - E T van Bavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C H Slump
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - C B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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11
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Li XG, Wang YB. SRPK1 gene silencing promotes vascular smooth muscle cell proliferation and vascular remodeling via inhibition of the PI3K/Akt signaling pathway in a rat model of intracranial aneurysms. CNS Neurosci Ther 2018; 25:233-244. [PMID: 30101479 DOI: 10.1111/cns.13043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/20/2018] [Accepted: 07/15/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Intracranial aneurysm (IA) is a life threatening cerebrovascular disease characterized by phenotypic modulation of vascular smooth muscle cells (VSMCs) and loss of vessel cells. In addition to environmental factors, genetic factors have been proposed to be a critical factor in the onset and progression of IA. The present study investigates the effects of serine-arginine protein kinase 1 (SRPK1) on VSMC proliferation and apoptosis both in vivo and in vitro, as well as its role in vascular remodeling in vivo through PI3 K/Akt signaling in IA. METHODS Differentially expressed genes related to IA were initially identified using microarray analysis. Immunohistochemistry was conducted to determine SRPK1 expression in the vascular walls in IA and normal cerebral vascular walls. TUNEL staining were applied to observe cell apoptosis patterns of VSMCs. VSMC proliferation and apoptosis in vitro were detected by cell counting kit-8 (CCK8) assay and flow cytometry. The expressions of SRPK1, PI3 K/Akt signaling pathway- and apoptosis-related genes were evaluated by RT-qPCR and Western blot analysis. RESULTS Microarray data of GSE36791 and GSE54083 were analyzed to determine the selection of SRPK1 gene. The vascular walls in IA rat models produced high levels of SRPK1 expression and an activated PI3 K/Akt signaling pathway. VSMCs treated with siRNA-SRPK1 exhibited enhanced cell proliferation, repressed cell apoptosis, and increased vascular remodeling, all of which suggest the inhibition of the PI3 K/AKT pathway. Notably, PI3 K/AKT pathway reversed the effect of SRPK1 silencing. CONCLUSION Our results show that siRNA-mediated silencing of SRPK1 gene inhibits VSMC apoptosis, and increases VSMCs proliferation and vascular remodeling in IA via the PI3 K/Akt signaling pathway. Our findings provide a novel intervention target for the molecular treatment of IA.
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Affiliation(s)
- Xin-Guo Li
- Department of Neurosurgery, the First Hospital of China Medical University, Shenyang, China
| | - Yi-Bao Wang
- Department of Neurosurgery, the First Hospital of China Medical University, Shenyang, China
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12
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Morphometry and hemodynamics of posterior communicating artery aneurysms: Ruptured versus unruptured. J Biomech 2018; 76:35-44. [DOI: 10.1016/j.jbiomech.2018.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/12/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022]
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13
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Bourcier R, Le Scouarnec S, Bonnaud S, Karakachoff M, Bourcereau E, Heurtebise-Chrétien S, Menguy C, Dina C, Simonet F, Moles A, Lenoble C, Lindenbaum P, Chatel S, Isidor B, Génin E, Deleuze JF, Schott JJ, Le Marec H, Loirand G, Desal H, Redon R, Desal H, Bourcier R, Daumas-Duport B, Isidor B, Connault J, Lebranchu P, Le Tourneau T, Viarouge MP, Papagiannaki C, Piotin M, Redjem H, Mazighi M, Desilles JP, Naggara O, Trystram D, Edjlali-Goujon M, Rodriguez C, Ben Hassen W, Saleme S, Mounayer C, Levrier O, Aguettaz P, Combaz X, Pasco A, Berthier E, Bintner M, Molho M, Gauthier P, Chivot C, Costalat V, Darganzil C, Bonafé A, Januel AC, Michelozzi C, Cognard C, Bonneville F, Tall P, Darcourt J, Biondi A, Iosif C, Pomero E, Ferre JC, Gauvrit JY, Eugene F, Raoult H, Gentric JC, Ognard J, Anxionnat R, Bracard S, Derelle AL, Tonnelet R, Spelle L, Ikka L, Fahed R, Rouchaud A, Ozanne A, Caroff J, Ben Achour N, Moret J, Chabert E, Berge J, Marnat G, Barreau X, Gariel F, Clarencon F, Aggour M, Ricolfi F, Chavent A, Thouant P, Lebidinsky P, Lemogne B, Herbreteau D, Bibi R, Pierot L, Soize S, Labeyrie MA, Vandendries C, Houdart E, Kazemi A, Leclerc X, Pruvo JP, Gallas S, Velasco S. Rare Coding Variants in ANGPTL6 Are Associated with Familial Forms of Intracranial Aneurysm. Am J Hum Genet 2018; 102:133-141. [PMID: 29304371 DOI: 10.1016/j.ajhg.2017.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022] Open
Abstract
Intracranial aneurysms (IAs) are acquired cerebrovascular abnormalities characterized by localized dilation and wall thinning in intracranial arteries, possibly leading to subarachnoid hemorrhage and severe outcome in case of rupture. Here, we identified one rare nonsense variant (c.1378A>T) in the last exon of ANGPTL6 (Angiopoietin-Like 6)-which encodes a circulating pro-angiogenic factor mainly secreted from the liver-shared by the four tested affected members of a large pedigree with multiple IA-affected case subjects. We showed a 50% reduction of ANGPTL6 serum concentration in individuals heterozygous for the c.1378A>T allele (p.Lys460Ter) compared to relatives homozygous for the normal allele, probably due to the non-secretion of the truncated protein produced by the c.1378A>T transcripts. Sequencing ANGPTL6 in a series of 94 additional index case subjects with familial IA identified three other rare coding variants in five case subjects. Overall, we detected a significant enrichment (p = 0.023) in rare coding variants within this gene among the 95 index case subjects with familial IA, compared to a reference population of 404 individuals with French ancestry. Among the 6 recruited families, 12 out of 13 (92%) individuals carrying IA also carry such variants in ANGPTL6, versus 15 out of 41 (37%) unaffected ones. We observed a higher rate of individuals with a history of high blood pressure among affected versus healthy individuals carrying ANGPTL6 variants, suggesting that ANGPTL6 could trigger cerebrovascular lesions when combined with other risk factors such as hypertension. Altogether, our results indicate that rare coding variants in ANGPTL6 are causally related to familial forms of IA.
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Bourcier R, Chatel S, Bourcereau E, Jouan S, Marec HL, Daumas-Duport B, Sevin-Allouet M, Guillon B, Roualdes V, Riem T, Isidor B, Lebranchu P, Connault J, Tourneau TL, Gaignard A, Loirand G, Redon R, Desal H. Understanding the Pathophysiology of Intracranial Aneurysm: The ICAN Project. Neurosurgery 2017; 80:621-626. [DOI: 10.1093/neuros/nyw135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND: Understanding the pathophysiologic mechanism of intracranial aneurysm (IA) formation is a prerequisite to assess the potential risk of rupture. Nowadays, there are neither reliable biomarkers nor diagnostic tools to predict the formation or the evolution of IA. Increasing evidence suggests a genetic component of IA but genetics studies have failed to identify genetic variation causally related to IA.
OBJECTIVE: To develop diagnostic and predictive tools for the risk of IA formation and rupture.
METHODS: The French ICAN project is a noninterventional nationwide and multicentric research program. Each typical IA of bifurcation will be included. For familial forms, further IA screening will be applied among first-degree relatives. By accurate phenotype description with high-throughput genetic screening, we aim to identify new genes involved in IA. These potential genetic markers will be tested in large groups of patients. Any relevant pathway identified will be further explored in a large cohort of sporadic carriers of IA, which will be well documented with clinical, biological, and imaging data.
EXPECTED OUTCOMES: Discovering genetic risk factors, better understanding the pathophysiology, and identifying molecular mechanisms responsible for IA formation will be essential bases for the development of biomarkers and identification of therapeutic targets.
DISCUSSION: Our protocol has many assets. A nationwide recruitment allows for the inclusion of large pedigrees with familial forms of IA. It will combine accurate phenotyping and comprehensive imaging with high-throughput genetic screening. Last, it will enable exploiting metadata to explore new pathophysiological pathways of interest by crossing clinical, genetic, biological, and imaging information.
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Affiliation(s)
- Romain Bourcier
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Stéphanie Chatel
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Emmanuelle Bourcereau
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Solène Jouan
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Hervé Le Marec
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
- Cardiology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Benjamin Daumas-Duport
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | | | - Benoit Guillon
- Neurology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Vincent Roualdes
- Neurosurgery Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Tanguy Riem
- Neurosurgery Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Bertrand Isidor
- Clinical genetics Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Pierre Lebranchu
- Ophtalmologic Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Jérôme Connault
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Thierry Le Tourneau
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
- Cardiology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Alban Gaignard
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Gervaise Loirand
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Richard Redon
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Hubert Desal
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
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Ramachandran M, Retarekar R, Raghavan ML, Berkowitz B, Dickerhoff B, Correa T, Lin S, Johnson K, Hasan D, Ogilvy C, Rosenwasser R, Torner J, Bogason E, Stapleton CJ, Harbaugh RE. Assessment of image-derived risk factors for natural course of unruptured cerebral aneurysms. J Neurosurg 2016; 124:288-95. [DOI: 10.3171/2015.2.jns142265] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECT
The goal of this prospective longitudinal study was to test whether image-derived metrics can differentiate unruptured aneurysms that will become unstable (grow and/or rupture) from those that will remain stable.
METHODS
One hundred seventy-eight patients harboring 198 unruptured cerebral aneurysms for whom clinical observation and follow-up with imaging surveillance was recommended at 4 clinical centers were prospectively recruited into this study. Imaging data (predominantly CT angiography) at initial presentation was recorded. Computational geometry was used to estimate numerous metrics of aneurysm morphology that described the size and shape of the aneurysm. The nonlinear, finite element method was used to estimate uniform pressure-induced peak wall tension. Computational fluid dynamics was used to estimate blood flow metrics. The median follow-up period was 645 days. Longitudinal outcome data on these aneurysm patients—whether their aneurysms grew or ruptured (the unstable group) or remained unchanged (the stable group)—was documented based on follow-up at 4 years after the beginning of recruitment.
RESULTS
Twenty aneurysms (10.1%) grew, but none ruptured. One hundred forty-nine aneurysms (75.3%) remained stable and 29 (14.6%) were lost to follow-up. None of the metrics—including aneurysm size, nonsphericity index, peak wall tension, and low shear stress area—differentiated the stable from unstable groups with statistical significance.
CONCLUSIONS
The findings in this highly selected group do not support the hypothesis that image-derived metrics can predict aneurysm growth in patients who have been selected for observation and imaging surveillance. If aneurysm shape is a significant determinant of invasive versus expectant management, selection bias is a key limitation of this study.
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Affiliation(s)
| | | | | | | | | | - Tatiana Correa
- 1Department of Biomedical Engineering, University of Iowa
| | - Steve Lin
- 1Department of Biomedical Engineering, University of Iowa
| | - Kevin Johnson
- 2Department of Neurosurgery, University of Iowa Hospitals and Clinics; and
| | - David Hasan
- 2Department of Neurosurgery, University of Iowa Hospitals and Clinics; and
| | - Christopher Ogilvy
- 3Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center; and
| | - Robert Rosenwasser
- 4Department of Neurosurgery, Jefferson University Hospital, Philadelphia
| | - James Torner
- 5Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Einar Bogason
- 6Department of Neurosurgery, Penn State University, Hershey; and
| | | | - Robert E. Harbaugh
- 6Department of Neurosurgery, Penn State University, Hershey; and
- 8Department of Engineering Science and Mechanics, Pennsylvania State University, State College, Pennsylvania
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16
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Frösen J. Flow Dynamics of Aneurysm Growth and Rupture: Challenges for the Development of Computational Flow Dynamics as a Diagnostic Tool to Detect Rupture-Prone Aneurysms. ACTA NEUROCHIRURGICA. SUPPLEMENT 2016; 123:89-95. [PMID: 27637634 DOI: 10.1007/978-3-319-29887-0_13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Saccular intracranial aneurysm (sIA) is a relatively common disease that can potentially cause a devastating, life-threatening intracranial hemorrhage. Many sIAs never rupture and thus do not necessitate interventions, making the detection of rupture-prone sIAs a very relevant clinical problem. Moreover, because currently available methods to prevent sIA rupture have significant risks of morbidity and mortality, diagnostic tools that can predict imminent rupture and help plan proper timing of prophylactic interventions, can improve patient care. Hemorrhage from an sIA occurs when hemodynamic stress exceeds sIA wall strength. Computational fluid dynamics (CFD) is a tool with which the hemodynamic stress to which the sIA wall is exposed can be determined non-invasively. Studies using CFD in sIAs have demonstrated associations of wall shear stress (WSS) with aneurysm growth, fragile sIA wall, and sIA rupture; these studies show the potential of CFD as a diagnostic tool. This review discusses the limitations of CFD and of the studies performed, and what needs to be done in order to develop CFD into a useful diagnostic tool to determine aneurysm-specific rupture risk.
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Affiliation(s)
- Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, 00029, Finland.
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17
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Kang H, Ji W, Qian Z, Li Y, Jiang C, Wu Z, Wen X, Xu W, Liu A. Aneurysm Characteristics Associated with the Rupture Risk of Intracranial Aneurysms: A Self-Controlled Study. PLoS One 2015; 10:e0142330. [PMID: 26540158 PMCID: PMC4634979 DOI: 10.1371/journal.pone.0142330] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022] Open
Abstract
This study analyzed the rupture risk of intracranial aneurysms (IAs) according to aneurysm characteristics by comparing the differences between two aneurysms in different locations within the same patient. We utilized this self-controlled model to exclude potential interference from all demographic factors to study the risk factors related to IA rupture. A total of 103 patients were diagnosed with IAs between January 2011 and April 2015 and were enrolled in this study. All enrolled patients had two IAs. One IA (the case) was ruptured, and the other (the control) was unruptured. Aneurysm characteristics, including the presence of a daughter sac, the aneurysm neck, the parent artery diameter, the maximum aneurysm height, the maximum aneurysm width, the location, the aspect ratio (AR, maximum perpendicular height/average neck diameter), the size ratio (SR, maximum aneurysm height/average parent diameter) and the width/height ratio (WH ratio, maximum aneurysm width/maximum aneurysm height), were collected and analyzed to evaluate the rupture risks of the two IAs within each patient and to identify the independent risk factors associated with IA rupture. Multivariate, conditional, backward, stepwise logistic regression analysis was performed to identify the independent risk factors associated with IA rupture. The multivariate analysis identified the presence of a daughter sac (odds ratio [OR], 13.80; 95% confidence interval [CI], 1.65-115.87), a maximum aneurysm height ≥7 mm (OR, 4.80; 95% CI, 1.21-18.98), location on the posterior communicating artery (PCOM) or anterior communicating artery (ACOM; OR, 3.09; 95% CI, 1.34-7.11) and SR (OR, 2.13; 95% CI, 1.16-3.91) as factors that were significantly associated with IA rupture. The presence of a daughter sac, the maximum aneurysm height, PCOM or ACOM locations and SR (>1.5±0.7) of unruptured IAs were significantly associated with IA rupture.
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Affiliation(s)
- Huibin Kang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenjun Ji
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zenghui Qian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Wen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenjuan Xu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
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18
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Ho AL, Lin N, Frerichs KU, Du R. Intrinsic, Transitional, and Extrinsic Morphological Factors Associated With Rupture of Intracranial Aneurysms. Neurosurgery 2015; 77:433-41; discussion 441-2. [PMID: 26075307 DOI: 10.1227/neu.0000000000000835] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND As diagnosis and treatment of unruptured intracranial aneurysms continues to increase, management principles remain largely based on size. This is despite mounting evidence that aneurysm location and other morphologic variables could play a role in predicting overall risk of rupture. Morphological parameters can be divided into 3 main groups, those that are intrinsic to the aneurysm, those that are extrinsic to the aneurysm, and those that involve both the aneurysm and surrounding vasculature (transitional). OBJECTIVE We present an evaluation of intrinsic, transitional, and extrinsic factors and their association with ruptured aneurysms. METHODS Using preoperative computed tomographic angiography, we generated 3-dimensional models of aneurysms and their surrounding vasculature with Slicer software. Using univariate and multivariate analyses, we examined the association of intrinsic, transitional, and extrinsic aspects of aneurysm morphology with rupture. RESULTS Between 2005 and 2013, 227 cerebral aneurysms in 4 locations were evaluated/treated at a single institution, and computed tomographic angiographies of 218 patients (97 unruptured and 130 ruptured) were analyzed. Ruptured aneurysms analyzed were associated with clinical factors of absence of multiple aneurysms and history of no prior rupture, and morphologic factors of greater aspect ratio. On multivariate analysis, aneurysm rupture remained associated with history of no prior rupture, greater flow angle, greater daughter-daughter vessel angle, and smaller parent-daughter vessel angle. CONCLUSION By studying the morphology of aneurysms and their surrounding vasculature, we identified several parameters associated with ruptured aneurysms that include intrinsic, transitional, and extrinsic factors of cerebral aneurysms and their surrounding vasculature.
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Affiliation(s)
- Allen L Ho
- *Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Stein KP, Wanke I, Forsting M, Zhu Y, Moldovan AS, Dammann P, Sandalcioglu IE, Sure U. Associated Aneurysms in Supratentorial Arteriovenous Malformations: Impact of Aneurysm Size on Haemorrhage. Cerebrovasc Dis 2015; 39:122-9. [DOI: 10.1159/000369958] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background: Associated aneurysms (AAs) are presumed to represent an additional risk factor for intracranial haemorrhage from cerebral arterio-venous malformations (AVMs). To date, efforts to capture their natural history, as well as to identify aneurysms with the potential capability of regression after AVM treatment remain incomprehensive. As the aneurysm size represents an important aspect for the treatment indication of incidental saccular aneurysms, this factor has rarely been encountered for the treatment of AAs so far. The present study aims to determine the angiographic and clinical characteristics of AAs with special focus on aneurysm size and their consequences for treatment. Methods: Patients with cerebral AVMs, treated in our department between 1990 and 2013, were analyzed retrospectively. Only patients with supratentorial AVMs and flow-related AAs of the feeding arteries were evaluated. Thus, patients harboring AVMs of the cerebellum and the brain stem and patients with intranidal, venous or remote aneurysms were excluded. Treatment strategies were assessed with special attention on bleeding source and on AA size. Results: In 59 of 409 patients (14%) with supratentorial AVMs, a total of 85 AAs of the feeding arteries were identified. 14 of 59 individuals (24%) presented with multiple AAs. Of 85 AA, 58 aneurysms (68%) were classified as proximal and 27 aneurysms (32%) as distal. The most common location of AAs was the middle cerebral artery (MCA, 39%), followed by the internal carotid artery (ICA, 27%) and the anterior cerebral artery (ACA, 21%). The mean AA size was 4.4 mm ± 3.4 mm. Intracranial haemorrhage was found in 21 of 59 patients (36%) with coexisting AAs. Among these, 10 individuals (17%) suffered from rupture of an AA, accounting for nearly half of all bleedings in this subgroup. Among those patients bearing a single AA, the size of ruptured aneurysms differed significantly from those unruptured (6.6 mm vs. 4.4 mm, p = 0.0046). Nineteen patients (32%) received treatment of 22 AAs, whereas sole AVM treatment was adopted in 26 patients (44%) and conservative management in 14 patients (24%). The main reasons to leave AAs untreated were the small AA size (<5 mm), poor clinical state or treatment denial by the patients. Conclusions: The aneurysm size of AAs in AVM influences the risk of haemorrhage. Therefore, the treatment of larger (diameter ≥5 mm) AAs should be considered, even if a treatment indication of the associated AVM is not given.
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20
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Ho AL, Mouminah A, Du R. Posterior cerebral artery angle and the rupture of basilar tip aneurysms. PLoS One 2014; 9:e110946. [PMID: 25353989 PMCID: PMC4212997 DOI: 10.1371/journal.pone.0110946] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/26/2014] [Indexed: 12/15/2022] Open
Abstract
Since the initial publication of the International Study of Unruptured Intracranial Aneurysms (ISUIA), management of unruptured intracranial aneurysms has been mainly based on the size of the aneurysm. The contribution of morphological characteristics to treatment decisions of unruptured aneurysms has not been well studied in a systematic and location specific manner. We present a large sample of basilar artery tip aneurysms (BTA) that were assessed using a diverse array of morphological variables to determine the parameters associated with ruptured aneurysms. Demographic and clinical risk factors of aneurysm rupture were obtained from chart review. CT angiograms (CTA) were evaluated with Slicer, an open source visualization and image analysis software, to generate 3-D models of the aneurysms and surrounding vascular architecture. Morphological parameters examined in each model included aneurysm volume, aspect ratio, size ratio, aneurysm angle, basilar vessel angle, basilar flow angle, and vessel to vessel angles. Univariate and multivariate analyses were performed to determine statistical significance. From 2008–2013, 54 patients with BTA aneurysms were evaluated in a single institution, and CTAs from 33 patients (15 ruptured, 18 unruptured) were available and analyzed. Aneurysms that underwent reoperation, that were associated with arteriovenous malformations, or that lacked preoperative CTA were excluded. Multivariate logistic regression revealed that a larger angle between the posterior cerebral arteries (P1-P1 angle, p = 0.037) was most strongly associated with aneurysm rupture after adjusting for other morphological variables. In this location specific study of BTA aneurysms, the larger the angle formed between posterior cerebral arteries was found to be a new morphological parameter significantly associated with ruptured BTA aneurysms. This is a physically intuitive parameter that can be measured easily and readily applied in the clinical setting.
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Affiliation(s)
- Allen L. Ho
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amr Mouminah
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Rose Du
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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21
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Backes D, Vergouwen MD, Velthuis BK, van der Schaaf IC, Bor ASE, Algra A, Rinkel GJ. Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients With Multiple Intracranial Aneurysms. Stroke 2014; 45:1299-303. [DOI: 10.1161/strokeaha.113.004421] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daan Backes
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mervyn D.I. Vergouwen
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K. Velthuis
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene C. van der Schaaf
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - A. Stijntje E. Bor
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ale Algra
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriel J.E. Rinkel
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., M.D.I.V., A.S.E.B., A.A., G.J.E.R.), Department of Radiology (B.K.V., I.C.v.d.S.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Factors affecting formation and rupture of intracranial saccular aneurysms. Neurosurg Rev 2013; 37:1-14. [PMID: 24306170 DOI: 10.1007/s10143-013-0501-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/31/2013] [Accepted: 08/11/2013] [Indexed: 01/19/2023]
Abstract
Unruptured intracranial aneurysms represent a decisional challenge. Treatment risks have to be balanced against an unknown probability of rupture. A better understanding of the physiopathology is the basis for a better prediction of the natural history of an individual patient. Knowledge about the possible determining factors arises from a careful comparison between ruptured versus unruptured aneurysms and from the prospective observation and analysis of unbiased series with untreated, unruptured aneurysms. The key point is the correct identification of the determining variables for the fate of a specific aneurysm in a given individual. Thus, the increased knowledge of mechanisms of formation and eventual rupture of aneurysms should provide significant clues to the identification of rupture-prone aneurysms. Factors like structural vessel wall defects, local hemodynamic stress determined also by peculiar geometric configurations, and inflammation as trigger of a wall remodeling are crucial. In this sense the study of genetic modifiers of inflammatory responses together with the computational study of the vessel tree might contribute to identify aneurysms prone to rupture. The aim of this article is to underline the value of a unifying hypothesis that merges the role of geometry, with that of hemodynamics and of genetics as concerns vessel wall structure and inflammatory pathways.
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23
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Lu J, Hu S, Raghavan ML. A shell-based inverse approach of stress analysis in intracranial aneurysms. Ann Biomed Eng 2013; 41:1505-15. [PMID: 23392863 DOI: 10.1007/s10439-013-0751-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
Predicting pressure induced wall stress in intracranial aneurysms continues to be of interest for aneurysm safety assessment. In quasi-static analysis, there are two distinct approaches that one may take, the forward approach and the inverse approach. The inverse approach starts from a deformed configuration and thus is naturally suited to image-based, patient-specific analysis. Early studies by the authors' team suggested that the inverse approach, in the context of estimating the wall stress in cerebral aneurysms, depends weakly on the material description. In this article, we present a population study to further demonstrate the inverse method, in particular, the remarkable feature of insensitivity to material properties. Twenty-six aneurysm models derived from patient-specific images were employed in the study. Wall stresses were predicted in both the inverse and forward approaches using three material models. Results showed that, while forward computation yielded up to ~100% stress difference between some materials, the inverse solutions stayed close across materials. The inverse method, in addition to being methodologically accurate in dealing with pre-deformations, has the added convenience of insensitivity to uncertainties in wall tissue properties. New insight into the stress-geometry relation was also discussed.
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Affiliation(s)
- Jia Lu
- Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242, USA.
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24
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Ramachandran M, Laakso A, Harbaugh RE, Raghavan ML. On the role of modeling choices in estimation of cerebral aneurysm wall tension. J Biomech 2012; 45:2914-9. [PMID: 23021608 DOI: 10.1016/j.jbiomech.2012.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess various approaches to estimating pressure-induced wall tension in intracranial aneurysms (IA) and their effect on the stratification of subjects in a study population. METHODS Three-dimensional models of 26 IAs (9 ruptured and 17 unruptured) were segmented from Computed Tomography Angiography (CTA) images. Wall tension distributions in these patient-specific geometric models were estimated based on various approaches such as differences in morphological detail utilized or modeling choices made. For all subjects in the study population, the peak wall tension was estimated using all investigated approaches and were compared to a reference approach-nonlinear finite element (FE) analysis using the Fung anisotropic model with regionally varying material fiber directions. Comparisons between approaches were focused toward assessing the similarity in stratification of IAs within the population based on peak wall tension. RESULTS The stratification of IAs tension deviated to some extent from the reference approach as less geometric detail was incorporated. Interestingly, the size of the cerebral aneurysm as captured by a single size measure was the predominant determinant of peak wall tension-based stratification. Within FE approaches, simplifications to isotropy, material linearity and geometric linearity caused a gradual deviation from the reference estimates, but it was minimal and resulted in little to no impact on stratifications of IAs. CONCLUSION Differences in modeling choices made without patient-specificity in parameters of such models had little impact on tension-based IA stratification in this population. Increasing morphological detail did impact the estimated peak wall tension, but size was the predominant determinant.
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Affiliation(s)
- Manasi Ramachandran
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
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25
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Laaksamo E, Tulamo R, Liiman A, Baumann M, Friedlander RM, Hernesniemi J, Kangasniemi M, Niemelä M, Laakso A, Frösen J. Oxidative Stress Is Associated With Cell Death, Wall Degradation, and Increased Risk of Rupture of the Intracranial Aneurysm Wall. Neurosurgery 2012; 72:109-17. [DOI: 10.1227/neu.0b013e3182770e8c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The cause of rupture of intracranial aneurysms (IA) is not well understood. We previously demonstrated that loss of cells from the IA wall is associated with wall degeneration and rupture.
OBJECTIVE:
To investigate the mechanisms mediating cell death in the IA wall.
METHODS:
Snap-frozen tissue samples from aneurysm fundi were studied with terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining and immunostaining (14 unruptured and 20 ruptured), as well as with Western blot (12 unruptured and 12 ruptured).
RESULTS:
Ruptured IA walls had more TUNEL-positive cells than unruptured walls (P < .001). Few cells positive for cleaved caspase-3 were detected. Cleaved caspase-9 (intrinsic activation of apoptosis) was significantly increased in ruptured IA walls, whereas cleaved caspase-8 (extrinsic activation of apoptosis) was not detected. Increased expression of hemeoxygenase-1, a marker for oxidative stress, was associated with IA wall degeneration and rupture.
CONCLUSION:
Our results show that programmed cell death is activated in the IA wall via the intrinsic pathway. High oxidative stress in the IA wall is probably a significant cause of the intrinsic activation of cell death.
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Affiliation(s)
| | | | - Arto Liiman
- Neurosurgery Research Group, Biomedicum Helsinki,
| | - Marc Baumann
- Protein Chemistry/Proteomics Laboratory, Institute of Biomedicine, University of Helsinki, Helsinki, Finland
| | - Robert M. Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Neuroapoptosis Laboratory, Harvard Medical School, Boston, Massachusetts
| | - Juha Hernesniemi
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Marko Kangasniemi
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center), Helsinki, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juhana Frösen
- Neurosurgery Research Group, Biomedicum Helsinki,
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Neuroapoptosis Laboratory, Harvard Medical School, Boston, Massachusetts
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