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Sunwoo J, Shah P, Thuptimdang W, Khaleel M, Chalacheva P, Kato RM, Coates TD, Khoo MCK. Functional near-infrared spectroscopy-based prefrontal cortex oxygenation during working memory tasks in sickle cell disease. NEUROPHOTONICS 2023; 10:045004. [PMID: 37854507 PMCID: PMC10581024 DOI: 10.1117/1.nph.10.4.045004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
Significance Sickle cell disease (SCD), characterized by painful vaso-occlusive crises, is associated with cognitive decline. However, objective quantification of cognitive decline in SCD remains a challenge, and the associated hemodynamics are unknown. Aim To address this, we utilized functional near-infrared spectroscopy (fNIRS) to measure prefrontal cortex (PFC) oxygenation responses to N -back working memory tasks in SCD patients and compared them with healthy controls. Approach We quantified the PFC oxygenation rate as an index of cognitive activity in each group and compared them. In half of the participants, a Stroop test was administered before they started N -back to elevate their baseline stress level. Results In SCD compared to healthy controls, we found that (1) under a high baseline stress level, there were significantly greater oxygenation responses during the 2-back task, further elevated with histories of stroke; (2) there was a marginally slower N -back response time, and it was even slower with a history of stroke; and (3) the task accuracy was not different. Conclusions Additional requirements for processing time, PFC resources, and PFC oxygenation in SCD patients offer an important basis for understanding their cognitive decline and highlight the potential of fNIRS for evaluating cognitive functions.
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Affiliation(s)
- John Sunwoo
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States
| | - Payal Shah
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Wanwara Thuptimdang
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Prince of Songkla University, Faculty of Medicine, Institute of Biomedical Engineering, Department of Biomedical Sciences and Biomedical Engineering, Hat Yai, Songkhla, Thailand
| | - Maha Khaleel
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Patjanaporn Chalacheva
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Roberta M. Kato
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Division of Pediatric Pulmonology, Los Angeles, California, United States
| | - Thomas D. Coates
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Michael C. K. Khoo
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
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Rogness VM, Juliette J, Khasabova IA, Gupta K, Khasabov SG, Simone DA. Descending Facilitation of Nociceptive Transmission From the Rostral Ventromedial Medulla Contributes to Hyperalgesia in Mice with Sickle Cell Disease. Neuroscience 2023; 526:1-12. [PMID: 37330194 PMCID: PMC10528639 DOI: 10.1016/j.neuroscience.2023.06.007] [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: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that is associated with acute episodic and chronic pain. Mice with SCD have robust hyperalgesia mediated, in part, by sensitization of spinal dorsal horn neurons. However, underlying mechanisms are not fully understood. Since the rostral ventromedial medulla (RVM) is a major component of descending circuitry that modulates nociceptive transmission in the spinal cord, we examined if the RVM contributes to hyperalgesia in mice with SCD. Injection of lidocaine, but not vehicle, into the RVM eliminated mechanical and heat hyperalgesia in sickle (HbSS-BERK) mice without altering mechanical and heat sensitivity in naïve C57B mice. These data indicate that the RVM contributes to the maintenance of hyperalgesia in mice with SCD. In electrophysiological studies, we determined the changes in response properties of RVM neurons that might contribute to hyperalgesia in sickle mice. Recordings were made from single ON, OFF, and Neutral cells in the RVM of sickle and control (HbAA-BERK) mice. Spontaneous activity and responses of ON, OFF and Neutral cells evoked by heat (50 °C) and mechanical (26 g) stimuli applied to the hind paw were compared between sickle and control mice. Although there were no differences in the proportions of functionally-identified neurons or spontaneous activity between sickle and control mice, evoked responses of ON cells to heat and mechanical stimuli were increased approximately 3-fold in sickle mice as compared to control mice. Thus, the RVM contributes to hyperalgesia in sickle mice via a specific ON cell-dependent descending facilitation of nociceptive transmission.
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Affiliation(s)
- Victoria M Rogness
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joseph Juliette
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Iryna A Khasabova
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kalpna Gupta
- Hematology/Oncology, Department of Medicine, University of California, Irvine and Southern California Institute for Research and Education, VA Medical Center, Long Beach, CA, USA
| | - Sergey G Khasabov
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Donald A Simone
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.
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Sop D, Steinberg JL, Jordan J, Crouch T, Zhang YM, Smith W. Association of Cerebral Hemodynamics and Anemia on Processing Speed in Adults with Sickle Cell Disease. JOURNAL OF NEUROLOGY AND EXPERIMENTAL NEURAL SCIENCE 2023; 5:150. [PMID: 37645351 PMCID: PMC10464389 DOI: 10.29011/2577-1442.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background and Purpose Compared to healthy controls, adult patients with Sickle Cell Disease (SCD) are anemic, and therefore have higher cardiac output and Cerebral Blood Flow (CBF) to maintain brain oxygenation. They also demonstrate comparatively more cognitive deficits due to either overt strokes or silent cerebral ischemia. However, there are few correlative studies between CBF and cognitive deficits, specifically processing speed in SCD. Such studies are important to develop biomarkers of central brain processing and ischemia for diagnosis, prognosis, and evaluating the effectiveness of potential interventions. This pilot cross-sectional study tested the hypotheses that adults with SCD and elevated CBF demonstrate lower central brain processing speed than controls on average and that CBF is inversely correlated with processing speed. Methods We conducted a pilot cross-sectional study to assess the relation-ships between CBF, central brain processing speed, and hemoglobin levels in asymptomatic adults with SCD and controls from an urban academic medical center. MRI acquisitions at 3T consisted of 2D phase-contrast quantitative arteriograms (Qflow) of the bilateral internal carotid and vertebral arteries and 3D pseudo-continuous arterial spin labeling (pCASL) of the brain. Participants were patients with SCD (hemoglobin [Hb]SS, [Hb] SBetaThal°, or [Hb]SC) aged 22-52 years of African American descent (N=7) or community controls (Hb AA) (n=3). Processing speed was assessed as an in-direct functional marker of ischemia using a recommended test from the NIH Toolbox for Assessment of Neurological and Behavioral Function, the Pattern Comparison Processing Speed Test. t-tests were used to compare means of CBF, hemoglobin, and cognition between SCD patients and healthy controls. Among SCD patients only multivariate correla-tions were used to evaluate relationships between brain perfusion in specific brain regions vs. processing speed and CBF. The significance level was set at p≤0.05. Results Adults with SCD reported higher CBF compared to healthy con-trols (72.15±28.90 vs. 47.23±12.30 ml/min/100g, p=0.04), and lower hemoglobin concentration (8.64±2.33 vs. 13.33±0.58, p=0.001). Heart rate in SCD patients was higher than in controls (86.29±1.37 vs. 74.00±2.10, p=0.04). Patients with SCD demonstrated lower processing speed (96.14±21.04 vs.123±13.74, p=0.02) than controls. Among adult patients with SCD, perfusion in specific regions of the brain showed an inverse relationship with processing speed, as did whole-brain CBF (p=0.0325). Conclusion These findings, although from a small sample, lend a degree of validity to the claim that processing speed is slower in people with SCD than in controls and that CBF is significantly higher in SCD patients com-pared to controls. The results also lend credence to the finding that the degree of processing speed deficiencies among adults with SCD is correlated with the degree of elevated CBF, which is known to correspond with the degree of anemia associated with SCD.
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Affiliation(s)
- Daniel Sop
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Joel L Steinberg
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA USA
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA USA
| | - Jennifer Jordan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Taylor Crouch
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Yue May Zhang
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Wally Smith
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
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Vu C, Bush A, Borzage M, Choi S, Coloigner J, Farzad S, Chai Y, Coates TD, Wood JC. Brain BOLD and NIRS response to hyperoxic challenge in sickle cell disease and chronic anemias. Magn Reson Imaging 2023; 100:26-35. [PMID: 36924810 PMCID: PMC10171837 DOI: 10.1016/j.mri.2023.03.002] [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] [Received: 01/03/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Congenital anemias, including sickle cell anemia and thalassemia, are associated with cerebral tissue hypoxia and heightened stroke risks. Recent works in sickle cell disease mouse models have suggested that hyperoxia respiratory challenges can identify regions of the brain having chronic tissue hypoxia. Therefore, this work investigated differences in hyperoxic response and regional cerebral oxygenation between anemic and healthy subjects. METHODS A cohort of 38 sickle cell disease subjects (age 22 ± 8 years, female 39%), 25 non-sickle anemic subjects (age 25 ± 11 years, female 52%), and 31 healthy controls (age 25 ± 10 years, female 68%) were examined. A hyperoxic gas challenge was performed with concurrent acquisition of blood oxygen level-dependent (BOLD) MRI and near-infrared spectroscopy (NIRS). In addition to hyperoxia-induced changes in BOLD and NIRS, global measurements of cerebral blood flow, oxygen delivery, and cerebral metabolic rate of oxygen were obtained and compared between the three groups. RESULTS Regional BOLD changes were not able to identify brain regions of flow limitation in chronically anemic patients. Higher blood oxygen content and tissue oxygenation were observed during hyperoxia gas challenge. Both control and anemic groups demonstrated lower blood flow, oxygen delivery, and metabolic rate compared to baseline, but the oxygen metabolism in anemic subjects were abnormally low during hyperoxic exposure. CONCLUSION These results indicated that hyperoxic respiratory challenge could not be used to identify chronically ischemic brain. Furthermore, the low hyperoxia-induced metabolic rate suggested potential negative effects of prolonged oxygen therapy and required further studies to evaluate the risk for hyperoxia-induced oxygen toxicity and cerebral dysfunction.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Adam Bush
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America; Department of Biomedical Engineering, University of Texas, Austin, TX, United States of America
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States of America; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States of America
| | - Julie Coloigner
- CIBORG Laboratory, Division of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States of America; Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, F-35000 Rennes, France
| | - Shayan Farzad
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Yaqiong Chai
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Thomas D Coates
- Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States of America; Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - John C Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America; Division of Cardiology, Departments of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States of America.
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Abdi SS, De Haan M, Kirkham FJ. Neuroimaging and Cognitive Function in Sickle Cell Disease: A Systematic Review. CHILDREN 2023; 10:children10030532. [PMID: 36980090 PMCID: PMC10047189 DOI: 10.3390/children10030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Sickle cell disease (SCD) is the most common inherited single-gene disease. Complications include chronic anaemia, reduced oxygen-carrying capability, and cerebral vasculopathy, resulting in silent cerebral infarction, stroke, and cognitive dysfunction with impairments in measures of executive function, attention, reasoning, language, memory, and IQ. This systematic review aims to investigate the association between neuroimaging findings and cognition in children with SCD. Searches of PubMed and Embase were conducted in March 2022. Studies were included if participants were <18 years, if original data were published in English between 1960 and 2022, if any genotype of SCD was included, and if the relationship between cognition and neuroimaging was examined. Exclusion criteria included case studies, editorials, and reviews. Quality was assessed using the Critical Appraisal Skills Programme Case Control Checklist. A total of 303 articles were retrieved; 33 met the eligibility criteria. The presence of overt or silent strokes, elevated blood flow velocities, abnormal functional connectivity, and decreased fMRI activation were associated with neuropsychological deficits in children with SCD when compared to controls. There is a critical need to address the disease manifestations of SCD early, as damage appears to begin at a young age. Most studies were cross-sectional, restricting the interpretation of the directionality of relationships. Future research employing longitudinal neuroimaging and neuropsychological assessments could improve our understanding of the cumulative consequences of SCD on the developing brain.
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Affiliation(s)
- Suad S. Abdi
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Michelle De Haan
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Fenella J. Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
- Child Health, University Hospital Southampton, Southampton SO16 6YD, UK
- Correspondence:
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6
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Ramos K, Guilliams KP, Fields ME. The Development of Neuroimaging Biomarkers for Cognitive Decline in Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1167-1186. [PMID: 36400537 PMCID: PMC9973749 DOI: 10.1016/j.hoc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sickle cell disease (SCD) is complicated by neurologic complications including vasculopathy, hemorrhagic or ischemic overt stroke, silent cerebral infarcts and cognitive dysfunction. Patients with SCD, even in the absence of vasculopathy or stroke, have experience cognitive dysfunction that progresses with age. Transcranial Doppler ultrasound and structural brain MRI are currently used for primary and secondary stroke prevention, but laboratory or imaging biomarkers do not currently exist that are specific to the risk of cognitive dysfunction in patients with SCD. Recent investigations have used advanced MR sequences assessing cerebral hemodynamics, white matter microstructure and functional connectivity to better understand the pathophysiology of cognitive decline in SCD, with the long-term goal of developing neuroimaging biomarkers to be used in risk prediction algorithms and to assess the efficacy of treatment options for patients with SCD.
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Affiliation(s)
- Kristie Ramos
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Melanie E Fields
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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7
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González-Zacarías C, Choi S, Vu C, Xu B, Shen J, Joshi AA, Leahy RM, Wood JC. Chronic anemia: The effects on the connectivity of white matter. Front Neurol 2022; 13:894742. [PMID: 35959402 PMCID: PMC9362738 DOI: 10.3389/fneur.2022.894742] [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: 03/12/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023] Open
Abstract
Chronic anemia is commonly observed in patients with hemoglobinopathies, mainly represented by disorders of altered hemoglobin (Hb) structure (sickle cell disease, SCD) and impaired Hb synthesis (e.g. thalassemia syndromes, non-SCD anemia). Both hemoglobinopathies have been associated with white matter (WM) alterations. Novel structural MRI research in our laboratory demonstrated that WM volume was diffusely lower in deep, watershed areas proportional to anemia severity. Furthermore, diffusion tensor imaging analysis has provided evidence that WM microstructure is disrupted proportionally to Hb level and oxygen saturation. SCD patients have been widely studied and demonstrate lower fractional anisotropy (FA) in the corticospinal tract and cerebellum across the internal capsule and corpus callosum. In the present study, we compared 19 SCD and 15 non-SCD anemia patients with a wide range of Hb values allowing the characterization of the effects of chronic anemia in isolation of sickle Hb. We performed a tensor analysis to quantify FA changes in WM connectivity in chronic anemic patients. We calculated the volumetric mean of FA along the pathway of tracks connecting two regions of interest defined by BrainSuite's BCI-DNI atlas. In general, we found lower FA values in anemic patients; indicating the loss of coherence in the main diffusion direction that potentially indicates WM injury. We saw a positive correlation between FA and hemoglobin in these same regions, suggesting that decreased WM microstructural integrity FA is highly driven by chronic hypoxia. The only connection that did not follow this pattern was the connectivity within the left middle-inferior temporal gyrus. Interestingly, more reductions in FA were observed in non-SCD patients (mainly along with intrahemispheric WM bundles and watershed areas) than the SCD patients (mainly interhemispheric).
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Affiliation(s)
- Clio González-Zacarías
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Chau Vu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Botian Xu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Jian Shen
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Anand A. Joshi
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Richard M. Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - John C. Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,*Correspondence: John C. Wood
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Stotesbury H, Kawadler JM, Clayden JD, Saunders DE, Hood AM, Koelbel M, Sahota S, Rees DC, Wilkey O, Layton M, Pelidis M, Inusa BPD, Howard J, Chakravorty S, Clark CA, Kirkham FJ. Quantification of Silent Cerebral Infarction on High-Resolution FLAIR and Cognition in Sickle Cell Anemia. Front Neurol 2022; 13:867329. [PMID: 35847220 PMCID: PMC9277177 DOI: 10.3389/fneur.2022.867329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/27/2022] [Indexed: 01/18/2023] Open
Abstract
Research in sickle cell anemia (SCA) has used, with limited race-matched control data, binary categorization of patients according to the presence or absence of silent cerebral infarction (SCI). SCI have primarily been identified using low-resolution MRI, with radiological definitions varying in lesion length and the requirement for abnormality on both fluid attenuated inversion recovery (FLAIR) and T1-weighted images. We aimed to assess the effect of published SCI definitions on global, regional, and lobar lesion metrics and their value in predicting cognition. One hundred and six patients with SCA and 48 controls aged 8-30 years underwent 3T MRI with a high-resolution FLAIR sequence and Wechsler cognitive assessment. Prevalence, number, and volume of lesions were calculated using a semi-automated pipeline for SCI defined as: (1) Liberal: any length (L-SCI); (2) Traditional: >3 mm in greatest dimension (T-SCI); (3) Restrictive; >3 mm in greatest dimension with a corresponding T1-weighted hypo-intensity (R-SCI). Globally, as hypothesized, there were large effects of SCI definition on lesion metrics in patients and controls, with prevalence varying from 24-42% in patients, and 4-23% in controls. However, contrary to hypotheses, there was no effect of any global metric on cognition. Regionally, there was a consistent distribution of SCI in frontal and parietal deep and juxta-cortical regions across definitions and metrics in patients, but no consistent distribution in controls. Effects of regional SCI metrics on cognitive performance were of small magnitude; some were paradoxical. These findings expose the challenges associated with the widespread use of SCI presence as a biomarker of white-matter injury and cognitive dysfunction in cross-sectional high-resolution MRI studies in patients with SCA. The findings indicate that with high-resolution MRI: (1) radiological definitions have a large effect on resulting lesion groups, numbers, and volumes; (2) there is a non-negligible prevalence of lesions in young healthy controls; and (3) at the group-level, there is no cross-sectional association between global lesion metrics and general cognitive impairment irrespective of lesion definition and metric. With high-resolution multi-modal MRI, the dichotomy of presence or absence of SCI does not appear to be a sensitive biomarker for the detection of functionally significant pathology; the search for appropriate endpoints for clinical treatment trials should continue.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan D Clayden
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anna M Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Melanie Koelbel
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sati Sahota
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Olu Wilkey
- North Middlesex University Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Layton
- Haematology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baba P D Inusa
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematology and Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Chris A Clark
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
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9
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Sahu T, Pande B, Sinha M, Sinha R, Verma HK. Neurocognitive Changes in Sickle Cell Disease: A Comprehensive Review. Ann Neurosci 2022; 29:255-268. [PMID: 37064288 PMCID: PMC10101159 DOI: 10.1177/09727531221108871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Sickle cell disease (SCD) is a type of hemoglobinopathy characterized by abnormal hemoglobin molecules, which includes numerous acute and chronic complications. Ischemic stroke, silent cerebral infarction, headache, and neurocognitive impairment are the most common neurological complications associated with SCD. Summary: Acute anemia because of SCD can cause cognitive impairments because of cerebral hypoxia. Cognitive abnormalities in SCD manifest in various aspects such as working memory, verbal learning, executive functions, and attention. These neurocognitive impairments have been associated with poor functional results, such as transitioning from juvenile to adult care, adherence to medications, and unemployment. Key message: In this review, we focus on neurocognitive aspects of SCD patients based on different imaging techniques, psychological batteries, associated neuromarkers, and interventions for managing of cognitive deficiencies..
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Affiliation(s)
- Tarun Sahu
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Babita Pande
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Meenakshi Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ramanjan Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of lungs Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum, Neuherberg, Munich, Germany
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Ni L, Sun W, Yang D, Huang L, Shao P, Wang C, Xu Y. The Cerebrovascular Reactivity-Adjusted Spontaneous Brain Activity Abnormalities in White Matter Hyperintensities Related Cognitive Impairment: A Resting-State Functional MRI Study. J Alzheimers Dis 2022; 86:691-701. [PMID: 35124642 DOI: 10.3233/jad-215216] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The BOLD signal is regulated by neuronal activity and vascular physiology. The evolution pattern of brain activities after modulating the vascular factors in white matter hyperintensities (WMHs) related cognitive impairment (CI) was unknown. OBJECTIVE To explore the "pure" low-frequency fluctuation (ALFF) alterations after adjusting the cerebrovascular reactivity (CVR) factor. METHODS In this study, 111 WMHs subjects including 55 with CI (WMH-CI) and 56 without CI (WMH-no-CI), and 72 normal controls (NCs) underwent resting-state fMRI. The CVR and ALFF maps were derived using BOLD data. A voxel-wise Pearson analysis was performed to detect the relationship between CVR and ALFF maps. The ANCOVA analysis with and without CVR as a covariate was conducted to explore the effect of CVR on ALFF analysis. Correlation between the ALFF alterations and cognitive performance was conducted in WMH-CI subjects. The receiver operating characteristic curve was constructed to assess the diagnostic performance of ALFF indexes to determine the occurrence of CI. RESULTS There was a significant widespread correlation between the CVR and ALFF maps. The ALFF alterations between the WMH groups and NC group with CVR as covariate were more than those without CVR as covariate. WMH-CI subjects showed further ALFF alterations when compared with WMH-no-CI subjects. The abnormal ALFF values were significantly associated with poor performance. The combination of inferior frontal gyrus and middle frontal gyrus to PCC provided an incremental contribution to the occurrence of CI. CONCLUSION More areas with abnormal ALFF values which were specific to the WMHs related cognitive dysfunction were detected when considering the impact of CVR.
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Affiliation(s)
- Ling Ni
- Department of Neurology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenshan Sun
- Department of Neurology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Dan Yang
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lili Huang
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Pengfei Shao
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chong Wang
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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11
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Alteration of grey matter volume is associated with pain and quality of life in children with sickle cell disease. Transl Res 2022; 240:17-25. [PMID: 34418575 DOI: 10.1016/j.trsl.2021.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
Pain is the most common symptom experienced by patients with sickle cell disease (SCD) and is associated with poor quality of life. We investigated the association between grey matter volume (GMV) and the frequency of pain crises in the preceding 12 months and SCD-specific quality of life (QOL) assessed by the PedsQLTM SCD module in 38 pediatric patients with SCD. Using voxel-based morphometry methodology, high-resolution T1 structural scans were preprocessed using SPM and further analyzed in SPSS. The whole brain multiple regression analysis identified that perigenual anterior cingulate cortex (ACC) GMV was negatively associated with the frequency of pain crises (r = -0.656, P = 0.003). A two-group t-test analysis showed that the subgroup having pain crisis/crises in the past year also showed significantly lower GMV at left supratemporal gyrus than the group without any pain crisis (p=0.024). The further 21 pain-related regions of interest (ROI) analyses identified a negative correlation between pregenual ACC (r = -0.551, P = 0.001), subgenual ACC (r = -0.540, P = 0.001) and the frequency of pain crises. Additionally, the subgroup with poorer QOL displayed significantly reduced GMV in the parahippocampus (left: P = 0.047; right: P = 0.024). The correlations between the cerebral structural alterations and the accentuated pain experience and QOL suggests a possible role of central mechanisms in SCD pain.
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12
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Vu C, Bush A, Choi S, Borzage M, Miao X, Nederveen AJ, Coates TD, Wood JC. Reduced global cerebral oxygen metabolic rate in sickle cell disease and chronic anemias. Am J Hematol 2021; 96:901-913. [PMID: 33891719 PMCID: PMC8273150 DOI: 10.1002/ajh.26203] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/18/2022]
Abstract
Anemia is the most common blood disorder in the world. In patients with chronic anemia, such as sickle cell disease or major thalassemia, cerebral blood flow increases to compensate for decreased oxygen content. However, the effects of chronic anemia on oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2 ) are less well understood. In this study, we examined 47 sickle-cell anemia subjects (age 21.7 ± 7.1, female 45%), 27 non-sickle anemic subjects (age 25.0 ± 10.4, female 52%) and 44 healthy controls (age 26.4 ± 10.6, female 71%) using MRI metrics of brain oxygenation and flow. Phase contrast MRI was used to measure resting cerebral blood flow, while T2 -relaxation-under-spin-tagging (TRUST) MRI with disease appropriate calibrations were used to measure OEF and CMRO2 . We observed that patients with sickle cell disease and other chronic anemias have decreased OEF and CMRO2 (respectively 27.4 ± 4.1% and 3.39 ± 0.71 ml O2 /100 g/min in sickle cell disease, 30.8 ± 5.2% and 3.53 ± 0.64 ml O2 /100 g/min in other anemias) compared to controls (36.7 ± 6.0% and 4.00 ± 0.65 ml O2 /100 g/min). Impaired CMRO2 was proportional to the degree of anemia severity. We further demonstrate striking concordance of the present work with pooled historical data from patients having broad etiologies for their anemia. The reduced cerebral oxygen extraction and metabolism are consistent with emerging data demonstrating increased non-nutritive flow, or physiological shunting, in sickle cell disease patients.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Adam Bush
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Xin Miao
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Aart J. Nederveen
- University of Amsterdam, Amsterdam UMC, Radiology and Nuclear Medicine, the Netherlands
| | - Thomas D. Coates
- Division of Hematology-Oncology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Division of Cardiology, Departments of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA
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13
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Stotesbury H, Kawadler JM, Saunders DE, Kirkham FJ. MRI detection of brain abnormality in sickle cell disease. Expert Rev Hematol 2021; 14:473-491. [PMID: 33612034 PMCID: PMC8315209 DOI: 10.1080/17474086.2021.1893687] [Citation(s) in RCA: 12] [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: 10/27/2020] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
Introduction: Over the past decades, neuroimaging studies have clarified that a significant proportion of patients with sickle cell disease (SCD) have functionally significant brain abnormalities. Clinically, structural magnetic resonance imaging (MRI) sequences (T2, FLAIR, diffusion-weighted imaging) have been used by radiologists to diagnose chronic and acute cerebral infarction (both overt and clinically silent), while magnetic resonance angiography and venography have been used to diagnose arteriopathy and venous thrombosis. In research settings, imaging scientists are increasingly applying quantitative techniques to shine further light on underlying mechanisms.Areas covered: From a June 2020 PubMed search of 'magnetic' or 'MRI' and 'sickle' over the previous 5 years, we selected manuscripts on T1-based morphometric analysis, diffusion tensor imaging, arterial spin labeling, T2-oximetry, quantitative susceptibility, and connectivity.Expert Opinion: Quantitative MRI techniques are identifying structural and hemodynamic biomarkers associated with risk of neurological and neurocognitive complications. A growing body of evidence suggests that these biomarkers are sensitive to change with treatments, such as blood transfusion and hydroxyurea, indicating that they may hold promise as endpoints in future randomized clinical trials of novel approaches including hemoglobin F upregulation, reduction of polymerization, and gene therapy. With further validation, such techniques may eventually also improve neurological and neurocognitive risk stratification in this vulnerable population.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jamie Michelle Kawadler
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dawn Elizabeth Saunders
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fenella Jane Kirkham
- Developmental Neurosciences Section, UCL Great Ormond Street Institute of Child Health, London, UK
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14
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Fields ME, Mirro AE, Guilliams KP, Binkley MM, Gil Diaz L, Tan J, Fellah S, Eldeniz C, Chen Y, Ford AL, Shimony JS, King AA, An H, Smyser CD, Lee JM. Functional Connectivity Decreases with Metabolic Stress in Sickle Cell Disease. Ann Neurol 2020; 88:995-1008. [PMID: 32869335 PMCID: PMC7592195 DOI: 10.1002/ana.25891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/16/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Children with sickle cell disease (SCD) experience cognitive deficits even when unaffected by stroke. Using functional connectivity magnetic resonance imaging (MRI) as a potential biomarker of cognitive function, we tested our hypothesis that children with SCD would have decreased functional connectivity, and that children experiencing the greatest metabolic stress, indicated by elevated oxygen extraction fraction, would have the lowest connectivity. METHODS We prospectively obtained brain MRIs and cognitive testing in healthy controls and children with SCD. RESULTS We analyzed data from 60 participants (20 controls and 40 with sickle cell disease). There was no difference in global cognition or cognitive subdomains between cohorts. However, we found decreased functional connectivity within the sensory-motor, lateral sensory-motor, auditory, salience, and subcortical networks in participants with SCD compared with controls. Further, as white matter oxygen extraction fraction increased, connectivity within the visual (p = 0.008, parameter estimate = -0.760 [95% CI = -1.297, -0.224]), default mode (p = 0.012, parameter estimate = -0.417 [95% CI = -0.731, -0.104]), and cingulo-opercular (p = 0.009, parameter estimate = -0.883 [95% CI = -1.517, -0.250]) networks decreased. INTERPRETATION We conclude that there is diminished functional connectivity within these anatomically contiguous networks in children with SCD compared with controls, even when differences are not seen with cognitive testing. Increased white matter oxygen extraction fraction was associated with decreased connectivity in select networks. These data suggest that elevated oxygen extraction fraction and disrupted functional connectivity are potentially presymptomatic neuroimaging biomarkers for cognitive decline in SCD. ANN NEUROL 2020;88:995-1008.
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Affiliation(s)
- Melanie E Fields
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy E Mirro
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael M Binkley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Luisa Gil Diaz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jessica Tan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Slim Fellah
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Program of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
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15
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Manara R, Dalla Torre A, Lucchetta M, Ermani M, Favaro A, Baracchini C, Favaretto S, Viaro F, Munaretto V, Sartori S, Ponticorvo S, Russo AG, Biffi A, Sainati L, Colombatti R. Visual cortex changes in children with sickle cell disease and normal visual acuity: a multimodal magnetic resonance imaging study. Br J Haematol 2020; 192:151-157. [PMID: 32789861 DOI: 10.1111/bjh.17042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Abstract
The visual system is primarily affected in sickle cell disease (SCD), and eye examination is recommended starting in late childhood. So far, to our knowledge, all studies have focused on the retina, neglecting the changes that might be present in the cortical portion of the visual system. We performed a multimodal magnetic resonance imaging (MRI) evaluation of the visual cortex in 25 children with SCD (mean age: 12·3 ± 1·9 years) and 31 controls (mean age: 12·7 ± 1·6 years). At ophthalmologic examination, 3/25 SCD children had mild visual acuity deficits and 2/25 had mild tortuosity of the retinal vessels. None showed optic pathway infarcts at MRI or Transcranial Doppler abnormal blood velocities, and 6/25 disclosed posterior cerebral artery stenosis (five mild and one severe) at MR-angiography. Compared to controls, SCD children had increased posterior pericalcarine cortical thickness, with a different trajectory of cortical maturation and decreased connectivity within medial and ventral visual neural networks. Our findings suggest that SCD affects the development and the tuning of the visual cortex, leading to anatomical and functional changes in childhood even in the absence of retinopathy, and set the basis for future studies to determine if these changes can represent useful predictors of visual impairment in adulthood, biomarkers of disease progression or treatment response.
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Affiliation(s)
- Renzo Manara
- Neuroradiology, Department of Neurosciences, University of Padova, Padova, Italy
| | - Alice Dalla Torre
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Marta Lucchetta
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Mario Ermani
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Claudio Baracchini
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Silvia Favaretto
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Federica Viaro
- Department of Neurosciences, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Vania Munaretto
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Stefano Sartori
- Neurology Unit, Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Sara Ponticorvo
- Department of Neuroradiology, University of Salerno, Salerno, Italy
| | - Andrea G Russo
- Department of Neuroradiology, University of Salerno, Salerno, Italy
| | - Alessandra Biffi
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Laura Sainati
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Raffaella Colombatti
- Department of Child and Woman's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
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16
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Do chronic pain and comorbidities affect brain function in sickle cell patients? A systematic review of neuroimaging and treatment approaches. Pain 2020; 160:1933-1945. [PMID: 31045749 DOI: 10.1097/j.pain.0000000000001591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) is a medical condition in which chronic pain is common and negatively impacts psychosocial function and quality of life. Although the brain mechanisms underlying chronic pain are well studied in other painful conditions, the brain mechanisms underlying chronic pain and the associated psychosocial comorbidities are not well established in SCD. A growing literature demonstrates the effect of treatment of chronic pain, including pharmacological and nonpharmacological treatments, on brain function. The present systematic review aimed to (1) determine the effects of chronic pain and psychosocial comorbidities on brain function of patients with SCD; (2) summarize pharmacological and nonpharmacological approaches to treat these symptoms; and (3) identify areas for further investigation of potential beneficial effects of treatments on brain function. Titles were screened using predefined criteria, including SCD, and abstracts and full texts were reviewed by 2 independent reviewers. A total of 1167 SCD articles were identified, and 86 full articles were included covering 3 sections: chronic pain (4 studies), psychosocial comorbidities (11 studies), and pharmacological and nonpharmacological treatments (71 studies). Neuroimaging evidence demonstrates aberrant neural processing related to chronic pain and psychosocial comorbidities in SCD beyond ischemic stroke and cerebral hemorrhage. Although neuroimaging studies show an important role for psychological factors, pain management is nearly exclusively based on opioids. Behavior therapy seems useful to improve psychological symptoms as well as chronic pain and quality of life. Further investigation is required with larger cohorts, matched controls, and examination of treatment-related neural mechanisms.
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17
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Vu C, Chai Y, Coloigner J, Nederveen AJ, Borzage M, Bush A, Wood JC. Quantitative perfusion mapping with induced transient hypoxia using BOLD MRI. Magn Reson Med 2020; 85:168-181. [PMID: 32767413 DOI: 10.1002/mrm.28422] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Gadolinium-based dynamic susceptibility contrast (DSC) is commonly used to characterize blood flow in patients with stroke and brain tumors. Unfortunately, gadolinium contrast administration has been associated with adverse reactions and long-term accumulation in tissues. In this work, we propose an alternative deoxygenation-based DSC (dDSC) method that uses a transient hypoxia gas paradigm to deliver a bolus of paramagnetic deoxygenated hemoglobin to the cerebral vasculature for perfusion imaging. METHODS Through traditional DSC tracer kinetic modeling, the MR signal change induced by this hypoxic bolus can be used to generate regional perfusion maps of cerebral blood flow, cerebral blood volume, and mean transit time. This gas paradigm and blood-oxygen-level-dependent (BOLD)-MRI were performed concurrently on a cohort of 66 healthy and chronically anemic subjects (age 23.5 ± 9.7, female 64%). RESULTS Our results showed reasonable global and regional agreement between dDSC and other flow techniques, such as phase contrast and arterial spin labeling. CONCLUSION In this proof-of-concept study, we demonstrated the feasibility of using transient hypoxia to generate a contrast bolus that mimics the effect of gadolinium and yields reasonable perfusion estimates. Looking forward, optimization of the hypoxia boluses and measurement of the arterial-input function is necessary to improve the accuracy of dDSC. Additionally, a cross-validation study of dDSC and DSC in brain tumor and ischemic stroke subjects is warranted to evaluate the clinical diagnostic utility of this approach.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yaqiong Chai
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Julie Coloigner
- Department of Radiology, CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Empenn ERL U 1228, Rennes, France
| | - Aart J Nederveen
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adam Bush
- Department of Radiology, Stanford University, Stanford, CA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - John C Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.,Division of Cardiology, Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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18
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Coloigner J, Vu C, Borzage M, Bush A, Choi S, Miao X, Chai Y, Galarza C, Lepore N, Tamrazi B, Coates TD, Wood JC. Transient Hypoxia Model Revealed Cerebrovascular Impairment in Anemia Using BOLD MRI and Near-Infrared Spectroscopy. J Magn Reson Imaging 2020; 52:1400-1412. [PMID: 32648323 DOI: 10.1002/jmri.27210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea and nocturnal oxygen desaturations, which are prevalent in sickle cell disease (SCD) and chronic anemia disorders, have been linked to risks of stroke and silent cerebral infarcts (SCI). Cerebrovascular response to intermittent desaturations has not been well studied and may identify patients at greatest risk. PURPOSE To investigate the cerebral dynamic response to induced desaturation in SCD patients with and without SCI, chronic anemia, and healthy subjects. STUDY TYPE Prospective. SUBJECTS Twenty-six SCD patients (age = 21 ± 8.2, female 46.2%), including 15 subjects without SCI and nine subjects with SCI, 15 nonsickle anemic patients (age = 22 ± 5.8, female 66.7%), and 31 controls (age = 28 ± 12.3, female 77.4%). FIELD STRENGTH/SEQUENCE 3T, gradient-echo echo-planar imaging. ASSESSMENT A transient hypoxia challenge of five breaths of 100% nitrogen gas was performed with blood oxygen level-dependent (BOLD) MRI and near-infrared spectroscopy (NIRS) acquisitions. Hypoxia responses were characterized by desaturation depth, time-to-peak, return-to-baseline half-life, and posthypoxia recovery in the BOLD and NIRS time courses. SCI were documented by T2 fluid-attenuation inversion recovery (FLAIR). STATISTICAL TESTS Univariate and multivariate regressions were performed between hypoxic parameters and anemia predictors. Voxelwise two-sample t-statistic maps were used to assess the regional difference in hypoxic responses between anemic and control groups. RESULTS Compared to controls, SCD and chronically anemic patients demonstrated significantly higher desaturation depth (P < 0.01) and shorter return-to-baseline timing response (P < 0.01). Patients having SCI had shorter time-to-peak (P < 0.01), return-to-baseline (P < 0.01), and larger desaturation depth (P < 0.01) in both white matter regions at risk and normal-appearing white matter than patients without infarcts. On multivariate analysis, desaturation depth and timing varied with age, sex, blood flow, white blood cells, and cell-free hemoglobin (r2 = 0.25 for desaturation depth; r2 = 0.18 for time-to-peak; r2 = 0.37 for return-to-baseline). DATA CONCLUSION Transient hypoxia revealed global and regional response differences between anemic and healthy subjects. SCI was associated with extensive heterogeneity of desaturation dynamics, consistent with extensive underlying microvascular remodeling.
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Affiliation(s)
- Julie Coloigner
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA.,Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Rennes, France
| | - Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Adam Bush
- Department of Radiology and Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Xin Miao
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Yaqiong Chai
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Cristina Galarza
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Natasha Lepore
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas D Coates
- Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John C Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA.,Division of Cardiology, Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
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19
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Farrell AT, Panepinto J, Carroll CP, Darbari DS, Desai AA, King AA, Adams RJ, Barber TD, Brandow AM, DeBaun MR, Donahue MJ, Gupta K, Hankins JS, Kameka M, Kirkham FJ, Luksenburg H, Miller S, Oneal PA, Rees DC, Setse R, Sheehan VA, Strouse J, Stucky CL, Werner EM, Wood JC, Zempsky WT. End points for sickle cell disease clinical trials: patient-reported outcomes, pain, and the brain. Blood Adv 2019; 3:3982-4001. [PMID: 31809538 PMCID: PMC6963237 DOI: 10.1182/bloodadvances.2019000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points.
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Affiliation(s)
| | - Julie Panepinto
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Ankit A Desai
- Krannert Institute of Cardiology, Indiana University, Bloomington, IN
| | - Allison A King
- Division of Hematology and Oncology in Pediatrics and Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Amanda M Brandow
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences
- Department of Neurology, and
- Department of Psychiatry, School of Medicine, Vanderbilt University, Nashville, TN
| | - Kalpna Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and
- Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Harvey Luksenburg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Vivien A Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John Strouse
- Division of Hematology, Department of Medicine, and
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Cheryl L Stucky
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Ellen M Werner
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John C Wood
- Children's Hospital Los Angeles, Los Angeles, CA; and
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's/School of Medicine, University of Connecticut, Hartford, CT
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20
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Karafin MS, Chen G, Wandersee NJ, Brandow AM, Hurley RW, Simpson P, Ward D, Li SJ, Field JJ. Chronic pain in adults with sickle cell disease is associated with alterations in functional connectivity of the brain. PLoS One 2019; 14:e0216994. [PMID: 31107926 PMCID: PMC6527293 DOI: 10.1371/journal.pone.0216994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 12/21/2022] Open
Abstract
Chronic pain affects 50% of adults with sickle cell disease (SCD). Although central sensitization is thought to contribute to the pathogenesis of this chronic pain, no studies have examined differences in functional connectivity of the brain between patients with SCD with and without chronic pain. We performed an observational cohort study using resting-state functional MRI (rsfMRI) of the brain on adults with SCD with and without chronic pain. We tested the hypothesis that, compared to those without chronic pain, those with chronic pain would have differences in functional connectivity between the periaqueductal grey (PAG) and other regions of the brain. Twenty-two adults with SCD, 15 with chronic pain and 7 without chronic pain, as well as 10 African-American controls, underwent rsfMRI of the brain. When SCD patients with chronic pain were compared to those without chronic pain, significant differences in connectivity were noted between the PAG and 9 regions of the brain, including several in the default mode network, a network involved in introspection that has been implicated in other chronic pain syndromes. Changes in functional connectivity between patients with SCD with and without chronic pain suggest a mechanism for chronic pain that involves neuro-plastic changes to the brain.
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Affiliation(s)
- Matthew S. Karafin
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
| | - Guangyu Chen
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Nancy J. Wandersee
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Amanda M. Brandow
- Department of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Robert W. Hurley
- Department of Anesthesia, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Doug Ward
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Shi-Jiang Li
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Joshua J. Field
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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21
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Bhatt RR, Zeltzer LK, Coloigner J, Wood JC, Coates TD, Labus JS. Patients with sickle-cell disease exhibit greater functional connectivity and centrality in the locus coeruleus compared to anemic controls. NEUROIMAGE-CLINICAL 2019; 21:101686. [PMID: 30690419 PMCID: PMC6356008 DOI: 10.1016/j.nicl.2019.101686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/13/2019] [Accepted: 01/20/2019] [Indexed: 01/18/2023]
Abstract
Patients with sickle-cell disease (SCD) have greater resting-state functional connectivity between the locus coeruleus (LC) and dorsolateral prefrontal cortex (dlPFC). Patients with SCD have greater resting state centrality of the LC SCD patients with chronic pain exhibited even greater functional connectivity between the LC and dlPFC. This study supports hyper-connectivity between the LC and PFC is a potential chronic pain generator.
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Affiliation(s)
- Ravi R Bhatt
- UCLA Pediatric Pain and Palliative Care Program, Division of Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Lonnie K Zeltzer
- UCLA Pediatric Pain and Palliative Care Program, Division of Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julie Coloigner
- Childrens Hospital Los Angeles, Department of Radiology, Los Angeles, CA, USA; Childrens Hospital Los Angeles, Department of Cardiology, Los Angeles, CA, USA
| | - John C Wood
- Childrens Hospital Los Angeles, Department of Radiology, Los Angeles, CA, USA; Childrens Hospital Los Angeles, Department of Cardiology, Los Angeles, CA, USA
| | - Tom D Coates
- Childrens Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles (CCCBD), Los Angeles, CA, USA
| | - Jennifer S Labus
- Center for Neurobiology of Stress and Resilience, Department of Medicine, Vatche and Tamar Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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