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Shadman J, Panahpour H, Alipour MR, Salimi A, Shahabi P, Azar SS. Investigating the therapeutic effects of nimodipine on vasogenic cerebral edema and blood-brain barrier impairment in an ischemic stroke rat model. Neuropharmacology 2024; 257:110054. [PMID: 38950691 DOI: 10.1016/j.neuropharm.2024.110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
Vasogenic brain edema, a potentially life-threatening consequence following an acute ischemic stroke, is a major clinical problem. This research aims to explore the therapeutic benefits of nimodipine, a calcium channel blocker, in mitigating vasogenic cerebral edema and preserving blood-brain barrier (BBB) function in an ischemic stroke rat model. In this research, animals underwent the induction of ischemic stroke via a 60-min blockage of the middle cerebral artery and treated with a nonhypotensive dose of nimodipine (1 mg/kg/day) for a duration of five days. The wet/dry method was employed to identify cerebral edema, and the Evans blue dye extravasation technique was used to assess the permeability of the BBB. Furthermore, immunofluorescence staining was utilized to assess the protein expression levels of matrix metalloproteinase-9 (MMP-9) and intercellular adhesion molecule-1 (ICAM-1). The study also examined mitochondrial function by evaluating mitochondrial swelling, succinate dehydrogenase (SDH) activity, the collapse of mitochondrial membrane potential (MMP), and the generation of reactive oxygen species (ROS). Post-stroke administration of nimodipine led to a significant decrease in cerebral edema and maintained the integrity of the BBB. The protective effects observed were associated with a reduction in cell apoptosis as well as decreased expression of MMP-9 and ICAM-1. Furthermore, nimodipine was observed to reduce mitochondrial swelling and ROS levels while simultaneously restoring MMP and SDH activity. These results suggest that nimodipine may reduce cerebral edema and BBB breakdown caused by ischemia/reperfusion. This effect is potentially mediated through the reduction of MMP-9 and ICAM-1 levels and the enhancement of mitochondrial function.
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Affiliation(s)
- Javad Shadman
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamdollah Panahpour
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | - Ahmad Salimi
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Parviz Shahabi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saied Salimpour Azar
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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2
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Wu H, Shi J, Sun X, Lu M, Liao A, Li Y, Xiao L, Zhou C, Dong W, Geng Z, Yuan L, Guo R, Chen M, Cheng X, Zhu W. Predictive effect of net water uptake on futile recanalisation in patients with acute large-vessel occlusion stroke. Clin Radiol 2024; 79:e599-e606. [PMID: 38310056 DOI: 10.1016/j.crad.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/03/2023] [Accepted: 01/06/2024] [Indexed: 02/05/2024]
Abstract
AIM To determine whether net water uptake (NWU) based on automated software evaluation could predict futile recanalisation in patients with acute anterior circulation large-vessel occlusion (LVO). MATERIALS AND METHODS Patients with acute anterior circulation LVO undergoing mechanical thrombectomy in Jinling Hospital were evaluated retrospectively. NWU and other baseline data were evaluated by performing univariate and multivariate analyses. The primary endpoint was 90-day modified Rankin scale score ≥3. A nomogram to predict poor clinical outcomes was developed based on multivariate logistic regression analysis. RESULTS Overall, 135 patients who underwent thrombectomy with a TICI grade ≥2b were enrolled. In multivariate logistic regression analysis, the following factors were identified as independent predictors of futile recanalisation: age (odds ratio [OR]: 1.055, 95 % confidence interval [CI]: 1.004-1.110, p=0.035), female (OR: 0.289, 95 % CI: 0.098-0.850, p=0.024), hypertension (OR: 3.182, 95 % CI: 1.160-8.728, p=0.025), high blood glucose level (OR: 1.36, 95 % CI: 1.087-1.701, p=0.007), admission National Institutes of Health Stroke Scale score (OR: 1.082, 95 % CI: 1.003-1.168, p=0.043), and NWU (OR: 1.312, 95 % CI: 1.038-1.659, p=0.023). CONCLUSIONS NWU based on Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) could be used to predict the occurrence of futile recanalisation in patients with acute anterior circulation LVO ischaemic stroke.
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Affiliation(s)
- H Wu
- Department of Neurology, Third People's Hospital of Yancheng, Yancheng 224001, Jiangsu, China; Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - J Shi
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - X Sun
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - M Lu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - A Liao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - Y Li
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu, China
| | - L Xiao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - C Zhou
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - W Dong
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - Z Geng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - L Yuan
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - R Guo
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
| | - M Chen
- Department of Neurology, Third People's Hospital of Yancheng, Yancheng 224001, Jiangsu, China
| | - X Cheng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China.
| | - W Zhu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China.
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3
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Gomez F, El-Ghanem M, Feldstein E, Jagdeo M, Koul P, Nuoman R, Gupta G, Gandhi CD, Amuluru K, Al-Mufti F. Cerebral Ischemic Reperfusion Injury: Preventative and Therapeutic Strategies. Cardiol Rev 2023; 31:287-292. [PMID: 36129330 DOI: 10.1097/crd.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute ischemic stroke is a leading cause of morbidity and mortality in the United States. Treatment goals remain focused on restoring blood flow to compromised areas. However, a major concern arises after reperfusion occurs. Cerebral ischemic reperfusion injury is defined as damage to otherwise salvageable brain tissue occurring with the reestablishment of the vascular supply to that region. The pool of eligible patients for revascularization continues to grow, especially with the recently expanded endovascular therapeutic window. Neurointensivists should understand and manage complications of successful recanalization. In this review, we examine the pathophysiology, diagnosis, and potential management strategies in cerebral ischemic reperfusion injury.
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Affiliation(s)
- Francisco Gomez
- From the Department of Neurology, University of Missouri School of Medicine, Columbia, MO
| | - Mohammad El-Ghanem
- Department of Neuroendovascular Surgery, HCA Houston Healthcare, Houston, TX
| | - Eric Feldstein
- Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY
| | - Matt Jagdeo
- Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY
| | - Prateeka Koul
- Department of Neurology, Northshore-Long Island Jewish Medical Center, Manhasset, NY
| | - Rolla Nuoman
- Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Chirag D Gandhi
- Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY
| | - Krishna Amuluru
- Department of Neurological Surgery, University of Indiana, Indianapolis, IN
| | - Fawaz Al-Mufti
- Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY
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4
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Jazaeri SZ, Taghizadeh G, Babaei JF, Goudarzi S, Saadatmand P, Joghataei MT, Khanahmadi Z. Aquaporin 4 beyond a water channel; participation in motor, sensory, cognitive and psychological performances, a comprehensive review. Physiol Behav 2023; 271:114353. [PMID: 37714320 DOI: 10.1016/j.physbeh.2023.114353] [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: 06/05/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023]
Abstract
Aquaporin 4 (AQP4) is a protein highly expressed in the central nervous system (CNS) and peripheral nervous system (PNS) as well as various other organs, whose different sites of action indicate its importance in various functions. AQP4 has a variety of essential roles beyond water homeostasis. In this article, we have for the first time summarized different roles of AQP4 in motor and sensory functions, besides cognitive and psychological performances, and most importantly, possible physiological mechanisms by which AQP4 can exert its effects. Furthermore, we demonstrated that AQP4 participates in pathology of different neurological disorders, various effects depending on the disease type. Since neurological diseases involve a spectrum of dysfunctions and due to the difficulty of obtaining a treatment that can simultaneously affect these deficits, it is therefore suggested that future studies consider the role of this protein in different functional impairments related to neurological disorders simultaneously or separately by targeting AQP4 expression and/or polarity modulation.
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Affiliation(s)
- Seyede Zohreh Jazaeri
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran; Division of Neuroscience, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Javad Fahanik Babaei
- Electrophysiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Goudarzi
- Experimental Medicine Research Center, Tehran University of medical Sciences, Tehran, Iran
| | - Pegah Saadatmand
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran; Division of Neuroscience, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Department of Innovation in Medical Education, Faculty of Medicine, Ottawa University, Ottawa, Canada.
| | - Zohreh Khanahmadi
- Department of Occupational Therapy, School of Rehabilitation Services, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Chen B, Kong X, Li Z, Hu W, Zhou H, Gao J, Cui Y, Li S, Wan Q, Feng Y. Downregulation of NF-κB by Shp-1 alleviates cerebral venous sinus thrombosis-induced brain edema via suppression of AQP4. J Stroke Cerebrovasc Dis 2022; 31:106570. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022] Open
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6
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Decompressive Craniectomy for Infarction and Intracranial Hemorrhages. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Braun T, Sünner L, Hachenberger M, Müller C, Wietelmann A, Juenemann M, Pons-Kühnemann J, Kaps M, Gerriets T, Tschernatsch M, Roth J, Yenigün M. Microbubble-mediated sonothrombolysis with BR38 of a venous full blood thrombus in a rat embolic stroke model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1061. [PMID: 34422973 PMCID: PMC8339866 DOI: 10.21037/atm-21-75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
Background Early recanalization of an occluded vessel is associated with a better clinical outcome in acute ischemic stroke. Intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is only available in a minority of patients and often fails to reopen the occluded vessel. Mechanical recanalization is more effective in this matter but only available for selected patients when a thrombectomy centre can be reached. Therefore, sonothrombolysis might represent an alternative or complementary approach. Here, we tested microbubble-mediated sonothrombolysis (mmSTL) in a thromboembolic stroke model for middle cerebral artery occlusion (MCAO) in rats. Methods Sixty-seven male Wistar rats underwent MCAO using an autologous full blood thrombus and were randomly assigned to four groups receiving rt-PA, mmSTL, a combination of both, or a placebo. Diagnostic workup included neurological examination, assessment of infarct size, and presence of intracerebral haemorrhage by magnetic resonance imaging (MRI) and presence of microbleedings in histological staining. Results Neurological examination revealed no differences between the treatment groups. In all treatment groups, there was a reduction in infarct size 24 hours after MCAO as compared to the placebo (P≤0.05), but there were no differences between the active treatment groups (P>0.05) (placebo 0.75±0.10 cm3; mmSTL 0.43±0.07 cm3; rt-PA 0.4±0.07 cm3; mmSTL + rt-PA 0.27±0.08 cm3). Histological staining displayed intracerebral microbleedings in all animals. The frequency of gross bleeding detected by MRI did not differ between the groups (placebo 3; mmSTL 4; rt-PA 2; mmSTL + rt-PA 2; P>0.05) and was not associated with worse performance in clinical testing (P>0.05). There were no statistical differences in the mortality between the groups (P>0.05). Conclusions Our study showed the efficacy and safety of mmSTL with or without rt-PA in an embolic rat stroke model using a continuous full blood thrombus. Sonothrombolysis might be useful for patients who need to be transported to a thrombectomy centre or for those with distal vessel occlusion.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Laura Sünner
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Maaike Hachenberger
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Clemens Müller
- Department of Radiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Astrid Wietelmann
- Scientific Service Group Magnetic Resonance Imaging, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Martin Juenemann
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
| | - Jörn Pons-Kühnemann
- Institute of Medical Informatics, Department of Medical Statistics, Justus-Liebig-University, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany
| | - Tibo Gerriets
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
| | - Marlene Tschernatsch
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
| | - Joachim Roth
- Department of Veterinarian Physiology and Biochemistry, Justus-Liebig-University, Giessen, Germany
| | - Mesut Yenigün
- Department of Neurology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Bad Nauheim, Germany
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8
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Kim ID, Cave JW, Cho S. Aflibercept, a VEGF (Vascular Endothelial Growth Factor)-Trap, Reduces Vascular Permeability and Stroke-Induced Brain Swelling in Obese Mice. Stroke 2021; 52:2637-2648. [PMID: 34192895 PMCID: PMC8312568 DOI: 10.1161/strokeaha.121.034362] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 12/27/2022]
Abstract
Background and Purpose Brain edema is an important underlying pathology in acute stroke, especially when comorbidities are present. VEGF (Vascular endothelial growth factor) signaling is implicated in edema. This study investigated whether obesity impacts VEGF signaling and brain edema, as well as whether VEGF inhibition alters stroke outcome in obese subjects. Methods High-fat diet-induced obese mice were subjected to a transient middle cerebral artery occlusion. VEGF-A and VEGFR2 (receptor) expression, infarct volume, and swelling were measured 3 days post-middle cerebral artery occlusion. To validate the effect of an anti-VEGF strategy, we used aflibercept, a fusion protein that has a VEGF-binding domain and acts as a decoy receptor, in human umbilical vein endothelial cells stimulated with rVEGF (recombinant VEGF; 50 ng/mL) for permeability and tube formation. In vivo, aflibercept (10 mg/kg) or IgG control was administered in obese mice 3 hours after transient 30 minutes middle cerebral artery occlusion. Blood-brain barrier integrity was assessed by IgG staining and dextran extravasation in the postischemic brain. A separate cohort of nonobese (lean) mice was subjected to 40 minutes middle cerebral artery occlusion to test the effect of aflibercept on malignant infarction. Results Compared with lean mice, obese mice had increased mortality, infarct volume, swelling, and blood-brain barrier disruption. These outcomes were also associated with increased VEGF-A and VEGFR2 expression. Aflibercept reduced VEGF-A-stimulated permeability and tube formation in human umbilical vein endothelial cells. Compared with the IgG-treated controls, mice treated with aflibercept had reduced mortality rates (40% versus 17%), hemorrhagic transformation (43% versus 27%), and brain swelling (28% versus 18%), although the infarct size was similar. In nonobese mice with large stroke, aflibercept neither improved nor exacerbated stroke outcomes. Conclusions The study demonstrates that aflibercept selectively attenuates stroke-induced brain edema and vascular permeability in obese mice. These findings suggest the repurposing of aflibercept to reduce obesity-enhanced brain edema in acute stroke.
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Affiliation(s)
- Il-doo Kim
- Burke Neurological Institute, White Plains, NY (I.-d.K., S.C.)
| | | | - Sunghee Cho
- Burke Neurological Institute, White Plains, NY (I.-d.K., S.C.)
- Feil Brain Mind Research Institute, Weill Cornell Medicine, New York, NY (S.C.)
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9
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Shi ZF, Fang Q, Chen Y, Xu LX, Wu M, Jia M, Lu Y, Wang XX, Wang YJ, Yan X, Dong LP, Yuan F. Methylene blue ameliorates brain edema in rats with experimental ischemic stroke via inhibiting aquaporin 4 expression. Acta Pharmacol Sin 2021; 42:382-392. [PMID: 32665706 PMCID: PMC8027449 DOI: 10.1038/s41401-020-0468-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022] Open
Abstract
Brain edema is a common and serious complication of ischemic stroke with limited effective treatment. We previously reported that methylene blue (MB) attenuated ischemic brain edema in rats, but the underlying mechanisms remained unknown. Aquaporin 4 (AQP4) in astrocytes plays a key role in brain edema. We also found that extracellular signal-regulated kinase 1/2 (ERK1/2) activation was involved in the regulation of AQP4 expression in astrocytes. In the present study, we investigated whether AQP4 and ERK1/2 were involved in the protective effect of MB against cerebral edema. Rats were subjected to transient middle cerebral artery occlusion (tMCAO), MB (3 mg/kg, for 30 min) was infused intravenously through the tail vein started immediately after reperfusion and again at 3 h after ischemia (1.5 mg/kg, for 15 min). Brain edema was determined by MRI at 0.5, 2.5, and 48 h after tMCAO. The decreases of apparent diffusion coefficient (ADC) values on diffusion-weighted MRI indicated cytotoxic brain edema, whereas the increase of T2 MRI values reflected vasogenic brain edema. We found that MB infusion significantly ameliorated cytotoxic brain edema at 2.5 and 48 h after tMCAO and decreased vasogenic brain edema at 48 h after tMCAO. In addition, MB infusion blocked the AQP4 increases and ERK1/2 activation in the cerebral cortex in ischemic penumbra at 48 h after tMCAO. In a cell swelling model established in cultured rat astrocyte exposed to glutamate (1 mM), we consistently found that MB (10 μM) attenuated cell swelling, AQP4 increases and ERK1/2 activation. Moreover, the ERK1/2 inhibitor U0126 (10 μM) had the similar effects as MB. These results demonstrate that MB improves brain edema and astrocyte swelling, which may be mediated by the inhibition of AQP4 expression via ERK1/2 pathway, suggesting that MB may be a potential choice for the treatment of brain edema.
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Affiliation(s)
- Zhong-Fang Shi
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing, 100070, China
| | - Qing Fang
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ye Chen
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Li-Xin Xu
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Min Wu
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Mei Jia
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yi Lu
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiao-Xuan Wang
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yu-Jiao Wang
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xu Yan
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Li-Ping Dong
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Fang Yuan
- Department of Pathophysiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Key Laboratory of Central Nervous System Injury, Beijing, 100070, China.
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10
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Juenemann M, Braun T, Schleicher N, Yeniguen M, Schramm P, Gerriets T, Ritschel N, Bachmann G, Obert M, Schoenburg M, Kaps M, Tschernatsch M. Neuroprotective mechanisms of erythropoietin in a rat stroke model. Transl Neurosci 2020; 11:48-59. [PMID: 33312715 PMCID: PMC7702138 DOI: 10.1515/tnsci-2020-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study was designed to investigate the indirect neuroprotective properties of recombinant human erythropoietin (rhEPO) pretreatment in a rat model of transient middle cerebral artery occlusion (MCAO). Methods One hundred and ten male Wistar rats were randomly assigned to four groups receiving either 5,000 IU/kg rhEPO intravenously or saline 15 minutes prior to MCAO and bilateral craniectomy or sham craniectomy. Bilateral craniectomy aimed at elimination of the space-consuming effect of postischemic edema. Diagnostic workup included neurological examination, assessment of infarct size and cerebral edema by magnetic resonance imaging, wet–dry technique, and quantification of hemispheric and local cerebral blood flow (CBF) by flat-panel volumetric computed tomography. Results In the absence of craniectomy, EPO pretreatment led to a significant reduction in infarct volume (34.83 ± 9.84% vs. 25.28 ± 7.03%; p = 0.022) and midline shift (0.114 ± 0.023 cm vs. 0.083 ± 0.027 cm; p = 0.013). We observed a significant increase in regional CBF in cortical areas of the ischemic infarct (72.29 ± 24.00% vs. 105.53 ± 33.10%; p = 0.043) but not the whole hemispheres. Infarct size-independent parameters could not demonstrate a statistically significant reduction in cerebral edema with EPO treatment. Conclusions Single-dose pretreatment with rhEPO 5,000 IU/kg significantly reduces ischemic lesion volume and increases local CBF in penumbral areas of ischemia 24 h after transient MCAO in rats. Data suggest indirect neuroprotection from edema and the resultant pressure-reducing and blood flow-increasing effects mediated by EPO.
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Affiliation(s)
- Martin Juenemann
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Tobias Braun
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Nadine Schleicher
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Mesut Yeniguen
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Patrick Schramm
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Tibo Gerriets
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231, Bad Nauheim, Germany
| | - Nouha Ritschel
- Max-Planck-Institute for Heart and Lung Research, Ludwigstraße 43, 61231, Bad Nauheim, Germany
| | - Georg Bachmann
- Department of Radiology, Kerckhoff Clinic, 61231, Bad Nauheim, Germany
| | - Martin Obert
- Department of Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Markus Schoenburg
- Department of Cardiac Surgery, Kerckhoff Clinic, 61231, Bad Nauheim, Germany
| | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Marlene Tschernatsch
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.,Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231, Bad Nauheim, Germany
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11
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Ding Y, Liu J, Xu Y, Dong X, Shao B. Evolutionary Adaptation of Aquaporin-4 in Yak ( Bos grunniens) Brain to High-Altitude Hypoxia of Qinghai-Tibetan Plateau. High Alt Med Biol 2020; 21:167-175. [PMID: 32155353 DOI: 10.1089/ham.2019.0076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: In high-altitude animals, brain cell resilience against hypoxia stress is one critical evolutionary step that has promoted individual survival and species adaptation to the environment. Aquaporin-4 (AQP4) is implicated in a number of physiopathological processes, particularly in the development of brain edema, and other functions such as the regulation of extracellular space volume, potassium buffering, waste clearance, and calcium signaling. Still, the role of AQP4 in the adaptation to high-altitude hypoxia remains unknown. The yak (Bos grunniens) is the only large mammal that is currently known to have adapted to the high-altitude hypoxic environment of the Qinghai-Tibet Plateau (>4000 m above sea level). Methods: In this study, we cloned the complementary DNA (cDNA) for yak AQP4 and analyzed structural differences of AQP4 between yak and cattle. We used reverse transcription quantitative polymerase chain reaction and western blot to investigate whether the expression of AQP4 mRNA and protein was different in brain of yak and cattle. In addition, immunohistochemistry was use to analyze the localization and expression of AQP4 in brain of yak and cattle. Results: Immunohistochemical results have shown that AQP4 is expressed in many regions of the yak brain, and both protein and messenger RNA (mRNA) levels are significantly lower than those of low-altitude cattle (Bos taurus). Phylogenetic analysis revealed that yak AQP4 is evolutionarily conserved. Interestingly, a substitution of Ala (cattle) to Ser in position 82, and eight additional amino acid residues composing an α-helix region are present in yak AQP4 protein. These sequence modifications potentially modulate the function of AQP4 in distinct environments. Conclusions: Our findings suggest that AQP4 may have an important role in the resistance to cerebral edema through low expression and maintenance of normal physiological function in the yak brain.
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Affiliation(s)
- Yanping Ding
- School of Life Sciences, Northwest Normal University, Lanzhou, P.R. China
| | - Jianfeng Liu
- School of Life Sciences, Lanzhou University, Lanzhou, P.R. China
| | - Yuanqing Xu
- School of Life Sciences, Lanzhou University, Lanzhou, P.R. China
| | - Xiaoqing Dong
- School of Life Sciences, Northwest Normal University, Lanzhou, P.R. China
| | - Baoping Shao
- School of Life Sciences, Lanzhou University, Lanzhou, P.R. China
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12
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Liu J, Li Y, Yu Y, Yuan X, Lv H, Liu L, Zhao Y, Wang Y, Ma Z. Simultaneous detection of cerebral blood perfusion and cerebral edema using swept-source optical coherence tomography. JOURNAL OF BIOPHOTONICS 2020; 13:e201960087. [PMID: 31702865 DOI: 10.1002/jbio.201960087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
The progression of ischemic cerebral edema (CE) is closely related to the level of cerebral blood perfusion (CBP) and affects each other. Simultaneous detection of CBP and CE is helpful in understanding the mechanisms of ischemic CE development. In this article, a wide field of view swept-source optical coherence tomography system was used to detect CE status and CBP levels simultaneously in middle cerebral artery occlusion rats. Images reflecting these two physiological states can be reconstructed with only one C-scan. We quantify these two physiological states into four parameters, which contain two vascular parameters (vascular displacement distance and vascular perfusion density) and two edema parameters (optical attenuation coefficient and edema area). The association between the two vascular parameters and the two edema parameters was analyzed. The results show that there is a strong linear relationship between blood flow parameters and edema parameters. This work provides a new option for CE in vivo detection, and is very likely to play an important role in the development of relevant drugs or in selection of treatment options.
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Affiliation(s)
- Jian Liu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Yan Li
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Yao Yu
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Xincheng Yuan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Hongyu Lv
- Department of Ophthalmology, Maternal and Child Health Hospital, Qinhuangdao, China
| | - Lanxiang Liu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Yuqian Zhao
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Yi Wang
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
| | - Zhenhe Ma
- School of Control Engineering, Northeastern University at Qinhuangdao, Qinhuangdao, China
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13
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Spellicy SE, Kaiser EE, Bowler MM, Jurgielewicz BJ, Webb RL, West FD, Stice SL. Neural Stem Cell Extracellular Vesicles Disrupt Midline Shift Predictive Outcomes in Porcine Ischemic Stroke Model. Transl Stroke Res 2019; 11:776-788. [PMID: 31811639 PMCID: PMC7340639 DOI: 10.1007/s12975-019-00753-4] [Citation(s) in RCA: 20] [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: 08/20/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance imaging (MRI) is a clinically relevant non-invasive imaging tool commonly utilized to assess stroke progression in real time. This study investigated the utility of MRI as a predictive measure of clinical and functional outcomes when a stroke intervention is withheld or provided, in order to identify biomarkers for stroke functional outcome under these conditions. Fifteen MRI and ninety functional parameters were measured in a middle cerebral artery occlusion (MCAO) porcine ischemic stroke model. Multiparametric analysis of correlations between MRI measurements and functional outcome was conducted. Acute axial and coronal midline shift (MLS) at 24 h post-stroke were associated with decreased survival and recovery measured by modified Rankin scale (mRS) and were significantly correlated with 52 measured acute (day 1 post) and chronic (day 84 post) gait and behavior impairments in non-treated stroked animals. These results suggest that MLS may be an important non-invasive biomarker that can be used to predict patient outcomes and prognosis as well as guide therapeutic intervention and rehabilitation in non-treated animals and potentially human patients that do not receive interventional treatments. Neural stem cell–derived extracellular vesicle (NSC EV) was a disruptive therapy because NSC EV administration post-stroke disrupted MLS correlations observed in non-treated stroked animals. MLS was not associated with survival and functional outcomes in NSC EV–treated animals. In contrast to untreated animals, NSC EVs improved stroked animal outcomes regardless of MLS severity.
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Affiliation(s)
- Samantha E Spellicy
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Erin E Kaiser
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Michael M Bowler
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
| | - Brian J Jurgielewicz
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | | | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Steven L Stice
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA.
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA.
- ArunA Biomedical, Athens, GA, 30602, USA.
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14
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Heterogeneity of Astrocytes in Grey and White Matter. Neurochem Res 2019; 46:3-14. [PMID: 31797158 DOI: 10.1007/s11064-019-02926-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
Astrocytes are a diverse and heterogeneous type of glial cells. The major task of grey and white matter areas in the brain are computation of information at neuronal synapses and propagation of action potentials along axons, respectively, resulting in diverse demands for astrocytes. Adapting their function to the requirements in the local environment, astrocytes differ in morphology, gene expression, metabolism, and many other properties. Here we review the differential properties of protoplasmic astrocytes of grey matter and fibrous astrocytes located in white matter in respect to glutamate and energy metabolism, to their function at the blood-brain interface and to coupling via gap junctions. Finally, we discuss how this astrocytic heterogeneity might contribute to the different susceptibility of grey and white matter to ischemic insults.
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15
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Liu J, Li Y, Yu Y, Yuan X, Lv H, Zhao Y, Ma Z. Cerebral edema detection in vivo after middle cerebral artery occlusion using swept-source optical coherence tomography. NEUROPHOTONICS 2019; 6:045007. [PMID: 31720312 PMCID: PMC6835117 DOI: 10.1117/1.nph.6.4.045007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Cerebral edema is a severe complication of ischemic cerebrovascular disease, which can lead to microcirculation compression resulting in additional ischemic damage. Real-time and continuous in vivo imaging techniques for edema detection are of great significance to basic research on cerebral edema. We attempted to monitor the cerebral edema status in rats with middle cerebral artery occlusion (MCAO) over time, using a wide field-of-view swept-source optical coherence tomography (SS-OCT) system. Optical attenuation coefficients (OACs) were calculated by an optimized depth-resolved estimation method, and en face OAC maps covering the whole cortex were obtained. Then, the tissue affected by edema was segmented from the OAC maps, and the cortical area affected by edema was estimated. Both magnetic resonance image (MRI) and brain water content measurements were used to verify the presence of cerebral edema. The results showed that the average OAC of the ischemic area gradually decreased as cerebral edema progressed, and the edema area detected by SS-OCT had high similarity in position and shape to that obtained by MRI. This work extends the application of OCT and provides an option for detecting cerebral edema in vivo after ischemic stroke.
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Affiliation(s)
- Jian Liu
- Northeastern University at Qinhuangdao, School of Control Engineering, Qinhuangdao, China
| | - Yan Li
- Northeastern University at Qinhuangdao, School of Control Engineering, Qinhuangdao, China
| | - Yao Yu
- Northeastern University at Qinhuangdao, School of Control Engineering, Qinhuangdao, China
| | - Xincheng Yuan
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States
| | - Hongyu Lv
- Maternal and Child Health Hospital, Department of Ophthalmology, Qinhuangdao, China
| | - Yuqian Zhao
- Northeastern University at Qinhuangdao, School of Control Engineering, Qinhuangdao, China
| | - Zhenhe Ma
- Northeastern University at Qinhuangdao, School of Control Engineering, Qinhuangdao, China
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16
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Yang WT, Wang Y, Shi YH, Fu H, Xu Z, Xu QQ, Zheng GQ. Herbal Compatibility of Ginseng and Rhubarb Exerts Synergistic Neuroprotection in Cerebral Ischemia/Reperfusion Injury of Rats. Front Physiol 2019; 10:1174. [PMID: 31572219 PMCID: PMC6753204 DOI: 10.3389/fphys.2019.01174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Objective Ischemic stroke is a complex multifactorial disease caused by interactions among polygenetic, environmental, and lifestyle factors with limited effective treatments. Multi-herbal formulae have long been used for stroke through herbal compatibility in traditional Chinese medicine (TCM); however, there is still a lack of evidence due to their unimaginable complexity. Herbal pairs represent the simplest and basic features of multi-herbal formulae, which are of great significance in clarifying herbal compatibility. Here, we aim to investigate the neuroprotective effects of the herbal compatibility of Ginseng and Rhubarb on a cerebral ischemia/reperfusion (I/R) injury model of rats. Methods Male adult SD rats were randomly divided into a sham group, a normal saline (NS) group, a Ginseng group, a Rhubarb group, and a Ginseng + Rhubarb (GR) group, a Carbenoxolone [CBX, gap junction (GJ) specific inhibitor] group, and a GR + CBX group. Each group was further assigned into four subgroups according to ischemic time (6 h, 1 day, 3 days, and 7 days). The cerebral I/R injury model was established according to the modified Zea Longa method. The Neurological Deficiency Score (NDS) was assessed by the Zea-Longa scale; the cerebral infarction area was detected by TTC (2,3,5-triphenyltetrazolium chloride) staining; and the expression of connexin-43 (Cx43) and aquaporin-4 (AQP4) were detected based on an immunofluorescence technique and quantitative real-time-PCR. Results Compared to the I/R group, both the independent and combined use of Ginseng and Rhubarb can significantly improve NDS (P < 0.05), decrease the percentage of the cerebral infarction area around the infarction penumbra (P < 0.05) and down-regulate the expression of Cx43 and AQP4 after I/R injury (P < 0.05). The GR had more significant effects than that of Ginseng and Rhubarb (P < 0.05). Compared with the GR group, the GR + CBX group significantly improved in NDS (P < 0.05), and decreased the percentage of the cerebral infarction area (P < 0.05) and expression of Cx43 and AQP4 protein (P < 0.05). Conclusion The herbal compatibility of Ginseng and Rhubarb synergistically exerts neuroprotective function during acute cerebral I/R injury, mainly through reducing the expression of Cx43 and AQP4.
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Affiliation(s)
- Wen-Ting Yang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong Wang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi-Hua Shi
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huan Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Qing Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guo-Qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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17
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Li Y, Xu QQ, Shan CS, Shi YH, Wang Y, Zheng GQ. Combined Use of Emodin and Ginsenoside Rb1 Exerts Synergistic Neuroprotection in Cerebral Ischemia/Reperfusion Rats. Front Pharmacol 2018; 9:943. [PMID: 30233364 PMCID: PMC6127650 DOI: 10.3389/fphar.2018.00943] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/02/2018] [Indexed: 12/24/2022] Open
Abstract
Acute ischemic stroke (AIS) generally causes neurological dysfunction and poses a serious threat to public health. Here, we aimed to assess the independent and combined effects of ginsenoside Rb1 (GRb1) and Emodin on neuroprotection through regulating Connexin 43 (Cx43) and Aquaporin 4 (AQP4) expression in cerebral ischemia/reperfusion (I/R) model rats. Adult male Sprague-Dawley (SD) rats were randomly divided into five groups: sham group, I/R group, Emodin group, GRb1 group and Emodin+GRb1 group. They were further allocated to four subgroups according to the 6h, 1d, 3d, and 7d time points except the sham group. Based on the modified Longa suture method, the focal cerebral I/R model was established by middle cerebral artery occlusion (MCAO). The neurological deficit scores (NDS), blood brain barrier (BBB) permeability and cerebral infarction area were assessed at each corresponding time point. Cx43 and AQP4 levels were assessed by Real-time PCR and Immunofluorescence. Compared with I/R group, both the independent and combined use of GRb1 and Emodin could alleviate NDS, reduce the BBB permeability, reduce the infarction area and down-regulate Cx43 and AQP4 expression at 6h, 1d, 3d, and 7d after I/R (P < 0.05). The Emodin+GRb1 group had more significant effects than Emodin group and GRb1 group (P < 0.05). In conclusion, the combination of Emodin and GRb1 exerts synergistically neuroprotective functions through regulating AQP4 and Cx43 after I/R.
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Affiliation(s)
- Yan Li
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Qing Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chun-Shuo Shan
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi-Hua Shi
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong Wang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guo-Qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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18
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Affiliation(s)
- Sunghee Cho
- From the Burke Medical Research Institute, White Plains, NY (S.C., J.Y.); and Feil Family Brain and Mind Research Institute, Departments of Neurology and Neuroscience, Weill Cornell Medicine, New York, NY (S.C.).
| | - Jiwon Yang
- From the Burke Medical Research Institute, White Plains, NY (S.C., J.Y.); and Feil Family Brain and Mind Research Institute, Departments of Neurology and Neuroscience, Weill Cornell Medicine, New York, NY (S.C.)
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19
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Nakano T, Nishigami C, Irie K, Shigemori Y, Sano K, Yamashita Y, Myose T, Tominaga K, Matsuo K, Nakamura Y, Ishikura H, Kamimura H, Egawa T, Mishima K. Goreisan Prevents Brain Edema after Cerebral Ischemic Stroke by Inhibiting Aquaporin 4 Upregulation in Mice. J Stroke Cerebrovasc Dis 2017; 27:758-763. [PMID: 29153303 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/29/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Aquaporin 4 (AQP4) is a water-selective transport protein expressed in astrocytes throughout the central nervous system. AQP4 level increases after cerebral ischemia and results in ischemic brain edema. Brain edema markedly influences mortality and motor function by elevating intracranial pressure that leads to secondary brain damage. Therefore, AQP4 is an important target to improve brain edema after cerebral ischemia. The Japanese herbal Kampo medicine, goreisan, is known to inhibit AQP4 activity. Here, we investigated whether goreisan prevents induction of brain edema by cerebral ischemia via AQP4 using 4-hour middle cerebral artery occlusion (4h MCAO) mice. METHODS Goreisan was orally administered at a dose of 500 mg/kg twice a day for 5 days before MCAO. AQP4 expression and motor coordination were measured by Western blotting and rotarod test, respectively. RESULTS Brain water content of 4h MCAO mice was significantly increased at 24 hours after MCAO. Treatment with goreisan significantly decreased both brain water content and AQP4 expression in the ischemic brain at 24 hours after MCAO. In addition, treatment with goreisan alleviated motor coordination deficits at 24 hours after MCAO. CONCLUSIONS The results of this study suggested that goreisan may be a useful new therapeutic option for ischemic brain edema.
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Affiliation(s)
- Takafumi Nakano
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan; Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan; Department of Pharmacy, Fukuoka University Hospital, Fukuoka, Japan
| | - Chisa Nishigami
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Keiichi Irie
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan.
| | - Yutaka Shigemori
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazunori Sano
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Yuta Yamashita
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Takayuki Myose
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Koji Tominaga
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Koichi Matsuo
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hidetoshi Kamimura
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan; Department of Pharmacy, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Egawa
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
| | - Kenichi Mishima
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Jyonan, Fukuoka, Japan
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20
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Lang GE, Vella D, Waters SL, Goriely A. Mathematical modelling of blood-brain barrier failure and oedema. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2017; 34:391-414. [PMID: 27305934 DOI: 10.1093/imammb/dqw009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 01/25/2023]
Abstract
Injuries such as traumatic brain injury and stroke can result in increased blood-brain barrier (BBB) permeability. This increase may lead to water accumulation in the brain tissue resulting in vasogenic oedema. Although the initial injury may be localized, the resulting oedema causes mechanical damage and compression of the vasculature beyond the original injury site. We employ a biphasic mixture model to investigate the consequences of BBB permeability changes within a region of brain tissue and the onset of vasogenic oedema. We find that such localized changes can indeed result in brain tissue swelling and suggest that the type of damage that results (stress damage or strain damage) depends on the ability of the brain to clear oedema fluid.
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Affiliation(s)
- Georgina E Lang
- Mathematical Institute, University of Oxford, Oxford, OX2 6GG, UK
| | - Dominic Vella
- Mathematical Institute, University of Oxford, Oxford, OX2 6GG, UK
| | - Sarah L Waters
- Mathematical Institute, University of Oxford, Oxford, OX2 6GG, UK
| | - Alain Goriely
- Mathematical Institute, University of Oxford, Oxford, OX2 6GG, UK
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21
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Angeli S, Stylianopoulos T. Experimental measurements and mathematical modeling towards quantification of brain swelling stress. J Biomech 2017; 56:42-47. [PMID: 28285745 DOI: 10.1016/j.jbiomech.2017.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/13/2017] [Accepted: 02/26/2017] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury results in brain tissue swelling which can be a life threatening condition due to skull confinement. While previous efforts successfully measured the exhibited volume change in brain tissue swelling, no data exist to provide information about the exhibited stresses. In this study, confined compression mechanical testing was employed to measure swelling stress in murine brain tissue samples by varying the ionic concentration of the bathing solutions. Subsequently, computer simulations of the experimental protocol were employed to confirm a triphasic mathematical model describing the effect and provide insights into the experimental data. We measured the swelling stress to be in the range of 1.2-6.7kPa (9.0-50.2mmHg) depending on the ionic strength of the bathing solution, while a good correspondence was demonstrated among the experimentally measured and simulated responses. Furthermore, the mathematical model featured the osmotic pressure as the primary contributor to the swelling stress, while a parametric analysis showed that the densities of the intracellular fixed charges and of the non-permeable solutes significantly affect the swelling stress.
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Affiliation(s)
- Stelios Angeli
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia 1678, Cyprus
| | - Triantafyllos Stylianopoulos
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia 1678, Cyprus.
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Goriely A, Weickenmeier J, Kuhl E. Stress Singularities in Swelling Soft Solids. PHYSICAL REVIEW LETTERS 2016; 117:138001. [PMID: 27715096 DOI: 10.1103/physrevlett.117.138001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Indexed: 06/06/2023]
Abstract
When a swelling soft solid is rigidly constrained on all sides except for a circular opening, it will bulge out to expand as observed during decompressive craniectomy, a surgical procedure used to reduce stresses in swollen brains. While the elastic energy of the solid decreases throughout this process, large stresses develop close to the opening. At the point of contact, the stresses exhibit a singularity similar to the ones found in the classic punch indentation problem. Here, we study the stresses generated by swelling and the evolution of the bulging shape associated with this process. We also consider the possibility of damage triggered by zones of either high shear stresses or high fiber stretches.
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Affiliation(s)
- Alain Goriely
- Mathematical Institute, University of Oxford, Oxford OX2 6GG, United Kingdom
| | | | - Ellen Kuhl
- Living Matter Laboratory, Stanford University, Stanford, California 94305, USA
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23
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Wang X, Liu Y, Sun Y, Liu W, Jin X. Blood brain barrier breakdown was found in non-infarcted area after 2-h MCAO. J Neurol Sci 2016; 363:63-8. [DOI: 10.1016/j.jns.2016.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/22/2016] [Accepted: 02/15/2016] [Indexed: 11/17/2022]
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Neugebauer H, Jüttler E, Mitchell P, Hacke W. Decompressive Craniectomy for Infarction and Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Walberer M, Rueger MA. The macrosphere model-an embolic stroke model for studying the pathophysiology of focal cerebral ischemia in a translational approach. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207251 DOI: 10.3978/j.issn.2305-5839.2015.04.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The main challenge of stroke research is to translate promising experimental findings from the bench to the bedside. Many suggestions have been made how to achieve this goal, identifying the need for appropriate experimental animal models as one key issue. We here discuss the macrosphere model of focal cerebral ischemia in the rat, which closely resembles the pathophysiology of human stroke both in its acute and chronic phase. Key pathophysiological processes such as brain edema, cortical spreading depolarizations (CSD), neuroinflammation, and stem cell-mediated regeneration are observed in this stroke model, following characteristic temporo-spatial patterns. Non-invasive in vivo imaging allows studying the macrosphere model from the very onset of ischemia up to late remodeling processes in an intraindividual and longitudinal fashion. Such a design of pre-clinical stroke studies provides the basis for a successful translation into the clinic.
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Affiliation(s)
- Maureen Walberer
- 1 Department of Neurology, University Hospital of Cologne, Cologne, Germany ; 2 Max-Planck-Institute for Metabolism Research, Cologne, Germany ; 3 Animal Welfare Office, University of Cologne, Germany
| | - Maria Adele Rueger
- 1 Department of Neurology, University Hospital of Cologne, Cologne, Germany ; 2 Max-Planck-Institute for Metabolism Research, Cologne, Germany ; 3 Animal Welfare Office, University of Cologne, Germany
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Juenemann M, Braun T, Doenges S, Nedelmann M, Mueller C, Bachmann G, Singh P, Blaes F, Gerriets T, Tschernatsch M. Aquaporin-4 autoantibodies increase vasogenic edema formation and infarct size in a rat stroke model. BMC Immunol 2015; 16:30. [PMID: 25986484 PMCID: PMC4437448 DOI: 10.1186/s12865-015-0087-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/25/2015] [Indexed: 01/01/2023] Open
Abstract
Background Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system, which is characterized by autoantibodies directed against the water channel aquaporin-4 (AQP4). As one of the main water regulators in the central nervous system, APQ4 is supposed to be involved in the dynamics of brain edema. Cerebral edema seriously affects clinical outcome after ischemic stroke; we therefore aimed to investigate whether NMO-antibodies may exert the same functional effects as an AQP4-inhibitor in-vivo in acute ischemic stroke. Methods Sixteen male Wistar rats were randomized into two groups twice receiving either purified NMO-IgG or immune globulin from healthy controls, 24 hours and 30 minutes before middle cerebral artery occlusion (MCAO) was performed. T2-weighted MRI was carried out 24 hours after MCAO. Results MRI-examination showed a significant increase of infarct size in relation to the cerebral hemisphere volume with NMO-IgG treated animals (27.1% ± 11.1% vs. 14.3% ± 7.2%; p < 0.05) when corrected for the space-occupying effect of vasogenic edema formation and similar results without edema correction (34.4% ± 16.4% vs. 17.5% ± 9.3%; p < 0.05). Furthermore, T2-RT revealed a significant increase in cortical brain water content of the treatment group (19.5 ms ± 9.7 ms vs. 9.2 ms ± 5.2 ms; p < 0.05). Conclusions These results support the functional impact of NMO-antibodies and also offer an in-vivo-applicable animal model to investigate the properties of AQP4 in ischemic stroke.
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Affiliation(s)
- Martin Juenemann
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany. .,Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Tobias Braun
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Simone Doenges
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Max Nedelmann
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany. .,Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Clemens Mueller
- Department of Radiology, Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Georg Bachmann
- Department of Radiology, Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Pratibha Singh
- Department of Pharmacology, Max-Planck-Institute for Heart and Lung Research, Ludwigstraße 43, 61231, Bad Nauheim, Germany.
| | - Franz Blaes
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Neurology, Kreiskrankenhaus Gummersbach, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany.
| | - Tibo Gerriets
- Heart & Brain Research Group, Justus-Liebig-University Giessen and Kerckhoff Clinic, Benekestrasse 2-8, 61231, Bad Nauheim, Germany. .,Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169, Friedberg, Germany.
| | - Marlene Tschernatsch
- Department of Neurology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
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Propagation of damage in brain tissue: coupling the mechanics of oedema and oxygen delivery. Biomech Model Mechanobiol 2015; 14:1197-216. [DOI: 10.1007/s10237-015-0665-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/05/2015] [Indexed: 11/26/2022]
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Goriely A, Geers MGD, Holzapfel GA, Jayamohan J, Jérusalem A, Sivaloganathan S, Squier W, van Dommelen JAW, Waters S, Kuhl E. Mechanics of the brain: perspectives, challenges, and opportunities. Biomech Model Mechanobiol 2015; 14:931-65. [PMID: 25716305 PMCID: PMC4562999 DOI: 10.1007/s10237-015-0662-4] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 02/14/2015] [Indexed: 12/24/2022]
Abstract
The human brain is the continuous subject of extensive investigation aimed at understanding its behavior and function. Despite a clear evidence that mechanical factors play an important role in regulating brain activity, current research efforts focus mainly on the biochemical or electrophysiological activity of the brain. Here, we show that classical mechanical concepts including deformations, stretch, strain, strain rate, pressure, and stress play a crucial role in modulating both brain form and brain function. This opinion piece synthesizes expertise in applied mathematics, solid and fluid mechanics, biomechanics, experimentation, material sciences, neuropathology, and neurosurgery to address today’s open questions at the forefront of neuromechanics. We critically review the current literature and discuss challenges related to neurodevelopment, cerebral edema, lissencephaly, polymicrogyria, hydrocephaly, craniectomy, spinal cord injury, tumor growth, traumatic brain injury, and shaken baby syndrome. The multi-disciplinary analysis of these various phenomena and pathologies presents new opportunities and suggests that mechanical modeling is a central tool to bridge the scales by synthesizing information from the molecular via the cellular and tissue all the way to the organ level.
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Affiliation(s)
- Alain Goriely
- Mathematical Institute, University of Oxford, Oxford, OX2 6GG, UK,
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Wang WW, Xie CL, Zhou LL, Wang GS. The function of aquaporin4 in ischemic brain edema. Clin Neurol Neurosurg 2014; 127:5-9. [PMID: 25306413 DOI: 10.1016/j.clineuro.2014.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/17/2014] [Accepted: 09/19/2014] [Indexed: 02/01/2023]
Abstract
Cerebral ischemia injury is a primary cause of human death and long-term disability. We know that the cerebral edema induced by ischemia injury has a fatal effect on humans, which is the main cause of death for cerebral ischemia because it produces elevated intracranial pressure that leads to secondary brain damage, such as further impaired vascular perfusion and herniation of brain. Therefore, reducing the severity of brain edema has become the main therapeutic strategy for the treatment of CI. However, current treatment options for brain edema are limited and problematic. Therefore, finding novel strategies for overcoming this problem is crucial. Numerous studies demonstrated that cerebral edema may be attenuated via the regulation of AQP4 expression, thus initiating a novel therapeutic strategy against this possibly fatal condition. This review focuses on the role of AQP4 in ischemic brain edema, and its prospect as a therapeutic target.
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Affiliation(s)
- Wen-Wen Wang
- The Center of Traditional Chinese Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-long Xie
- Department of Neurology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Li-Li Zhou
- Department of Neurology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Guo-Sheng Wang
- Department of Oncology, The First Affiliated Hospital Beilun Branch of Zhejiang University, College of Medicine, Ningbo 315806, China.
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Lang GE, Stewart PS, Vella D, Waters SL, Goriely A. Is the Donnan effect sufficient to explain swelling in brain tissue slices? J R Soc Interface 2014; 11:20140123. [PMID: 24759543 DOI: 10.1098/rsif.2014.0123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Brain tissue swelling is a dangerous consequence of traumatic injury and is associated with raised intracranial pressure and restricted blood flow. We consider the mechanical effects that drive swelling of brain tissue slices in an ionic solution bath, motivated by recent experimental results that showed that the volume change of tissue slices depends on the ionic concentration of the bathing solution. This result was attributed to the presence of large charged molecules that induce ion concentration gradients to ensure electroneutrality (the Donnan effect), leading to osmotic pressures and water accumulation. We use a mathematical triphasic model for soft tissue to characterize the underlying processes that could lead to the volume changes observed experimentally. We suggest that swelling is caused by an osmotic pressure increase driven by both non-permeating solutes released by necrotic cells, in addition to the Donnan effect. Both effects are necessary to explain the dependence of the tissue slice volume on the ionic bath concentration that was observed experimentally.
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Ratilal BO, Arroja MMC, Rocha JPF, Fernandes AMA, Barateiro AP, Brites DMTO, Pinto RMA, Sepodes BMN, Mota-Filipe HD. Neuroprotective effects of erythropoietin pretreatment in a rodent model of transient middle cerebral artery occlusion. J Neurosurg 2014; 121:55-62. [PMID: 24702327 DOI: 10.3171/2014.2.jns132197] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED OBJECT.: There is an unmet clinical need to develop neuroprotective agents for neurosurgical and endovascular procedures that require transient cerebral artery occlusion. The aim in this study was to explore the effects of a single dose of recombinant human erythropoietin (rhEPO) before middle cerebral artery (MCA) occlusion in a focal cerebral ischemia/reperfusion model. METHODS Twenty-eight adult male Wistar rats were subjected to right MCA occlusion via the intraluminal thread technique for 60 minutes under continuous cortical perfusion monitoring by laser Doppler flowmetry. Rats were divided into 2 groups: control and treatment. In the treated group, rhEPO (1000 IU/kg intravenously) was administered 10 minutes before the onset of the MCA ischemia. At 24-hour reperfusion, animals were examined for neurological deficits, blood samples were collected, and animals were killed. The following parameters were evaluated: brain infarct volume, ipsilateral hemispheric edema, neuron-specific enolase plasma levels, parenchyma histological features (H & E staining), Fluoro-Jade-positive neurons, p-Akt and total Akt expression by Western blot analysis, and p-Akt-positive nuclei by immunohistochemical investigation. RESULTS Infarct volume and Fluoro-Jade staining of degenerating neurons in the infarct area did not vary between groups. The severity of neurological deficit (p < 0.001), amount of brain edema (78% reduction in treatment group, p < 0.001), and neuron-specific enolase plasma levels (p < 0.001) were reduced in the treatment group. Perivascular edema was histologically less marked in the treatment group. No variations in the expression or localization of p-Akt were seen. CONCLUSIONS Administration of rhEPO before the onset of 60-minute transient MCA ischemia protected the brain from this insult. It is unlikely that rhEPO pretreatment leads to direct neuronal antiapoptotic effects, as supported by the lack of Akt activation, and its benefits are most probably related to an indirect effect on brain edema as a consequence of blood-brain barrier preservation. Although research on EPO derivatives is increasing, rhEPO acts through distinct neuroprotective pathways and its clinical safety profile is well known. Clinically available rhEPO is a potential therapy for prevention of neuronal injury induced by transitory artery occlusion during neurovascular procedures.
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Huang J, Sun SQ, Lu WT, Xu J, Gan SW, Chen Z, Qiu GP, Huang SQ, Zhuo F, Liu Q, Xu SY. The internalization and lysosomal degradation of brain AQP4 after ischemic injury. Brain Res 2013; 1539:61-72. [PMID: 24070677 DOI: 10.1016/j.brainres.2013.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/19/2013] [Accepted: 09/18/2013] [Indexed: 11/25/2022]
Abstract
The membrane-bound water channel aquaporin-4 (AQP4) plays a significant role in maintaining brain water homeostasis. In ischemic brain, changes in the expression level of AQP4 have been reported. Previous studies suggest that the internalization of several membrane-bound proteins, including AQP4, may occur with or without lysosomal degradation. In this study, the internalization of AQP4 was detected in the ischemic rat brain via double immunofluorescence labeling. Specifically, AQP4 and early endosome antigen-1 (EEA1) co-localized after 1 h post-ischemic injury. Moreover, the co-expression of AQP4 and lysosomal-associated membrane protein-1 (LAMP1) was observed after 3 h post-ischemia. These findings suggest that AQP4 is internalized and the lysosome is involved in degrading the internalized AQP4 in the ischemic brain. AQP4 is known to be downregulated by the protein kinase C activator phorbol 12-myristate 13-acetate (PMA) in vivo and in vitro. The results in this study displayed that PMA infusion could decrease brain edema accompanied by AQP4 downregulation in ischemic brain. However, compared with vehicle infusion, PKC activator infusion did not increase the ratio of internalized or lysosomal degraded AQP4. That is, we have not found out evidence to prove protein kinase C activator PMA can promote the internalization or lysosomal degradation of AQP4 in the ischemic brain.
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Affiliation(s)
- Juan Huang
- Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, People's Republic of China; Department of Anatomy, Chongqing Medical University, Chongqing 400016, People's Republic of China
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Hemicraniectomy in the management of space-occupying ischemic stroke. J Clin Neurosci 2013; 20:6-12. [DOI: 10.1016/j.jocn.2012.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 01/04/2023]
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Hyun SW, Jang M, Park SW, Kim EJ, Jung YS. Onion (Allium cepa) extract attenuates brain edema. Nutrition 2012; 29:244-9. [PMID: 22771051 DOI: 10.1016/j.nut.2012.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 12/05/2011] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study investigated the potential beneficial effects of onion extract on brain ischemia-induced edema and blood-brain barrier (BBB) dysfunction. The possible underlying mechanisms are investigated, especially those linked to the antioxidant effects of the onion extract. METHODS Brain ischemia was induced by middle cerebral artery occlusion (MCAO) for 2 h followed by reperfusion in mice. Mice were treated intravenously with onion extract 30 min before MCAO. Brain edema and BBB hyperpermeability were evaluated by the measurement of the brain water content and Evans blue extravasation, respectively. The disruption of tight junction proteins was examined by immunohistochemical staining. The level of malondialdehyde was determined using the thiobarbituric acid method. The activities of glutathione peroxidase and catalase were determined by spectrophotometric assay. RESULTS Brain water content in the ischemic hemisphere was significantly reduced by treatment with onion extract. Onion extract also had a significant effect on both the decrease in Evans blue extravasation and the inhibition of zonula occludens-1 and occludin disruption caused by brain ischemia. In addition, onion extract significantly prevented brain ischemia-induced reduction in catalase and glutathione peroxidase activities and elevation of malondialdehyde level in the brain tissue. CONCLUSION The results from this study demonstrate that onion extract prevents brain edema, BBB hyperpermeability, and tight junction proteins disruption, possibly through its antioxidant effects in the mouse MCAO model. This study suggests that onion extract may be a beneficial nutrient for the prevention of BBB function during brain ischemia.
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Affiliation(s)
- Soo-Wang Hyun
- Department of Physiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Yoo AJ, Sheth KN, Kimberly WT, Chaudhry ZA, Elm JJ, Jacobson S, Davis SM, Donnan GA, Albers GW, Stern BJ, González RG. Validating imaging biomarkers of cerebral edema in patients with severe ischemic stroke. J Stroke Cerebrovasc Dis 2012; 22:742-9. [PMID: 22325573 DOI: 10.1016/j.jstrokecerebrovasdis.2012.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/02/2012] [Accepted: 01/08/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is no validated neuroimaging marker for quantifying brain edema. We sought to test whether magnetic resonance imaging (MRI)-based metrics would reliably change during the early subacute period in a manner consistent with edema and whether they would correlate with relevant clinical endpoints. METHODS Serial MRI studies from patients in the Echoplanar Imaging Thrombolytic Evaluation Trial with initial diffusion-weighted imaging (DWI) lesion volume >82 cm(3) were analyzed. Two independent readers outlined the hemisphere and lateral ventricle on the involved side and calculated respective volumes at baseline and days 3 to 5. We assessed interrater agreement, volume change between scans, and the association of volume change with early neurologic deterioration (National Institutes of Health Stroke Scale score worsening of ≥ 4 points), a 90-day modified Rankin scale (mRS) score of 0 to 4, and mortality. RESULTS Of 12 patients who met study criteria, average baseline and follow-up DWI lesion size was 138 cm(3) and 234 cm(3), respectively. The mean time to follow-up MRI was 62 hours. Concordance correlation coefficients between readers were >0.90 for both hemisphere and ventricle volume assessment. Mean percent hemisphere volume increase was 16.2 ± 8.3% (P < .0001), and the mean percent ventricle volume decrease was 45.6 ± 16.9% (P < .001). Percent hemisphere growth predicted early neurologic deterioration (area under the curve [AUC] 0.92; P = .0005) and 90-day mRS 0 to 4 (AUC 0.80; P = .02). CONCLUSIONS In this exploratory analysis of severe ischemic stroke patients, statistically significant changes in hemisphere and ventricular volumes within the first week are consistent with expected changes of cerebral edema. MRI-based analysis of hemisphere growth appears to be a suitable biomarker for edema formation.
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Affiliation(s)
- Albert J Yoo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Lu HT, Zhao JG, Li MH, Li YD. Application of albumin prior to delayed thrombolysis reduces brain edema and blood brain barrier permeability in an embolic stroke model. Brain Res 2012; 1438:75-84. [DOI: 10.1016/j.brainres.2011.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 11/26/2011] [Accepted: 12/13/2011] [Indexed: 11/17/2022]
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Abstract
Cerebral edema is a common finding in a variety of neurological conditions, including ischemic stroke, traumatic brain injury, ruptured cerebral aneurysm, and neoplasia. With the possible exception of neoplasia, most pathological processes leading to edema seem to share similar molecular mechanisms of edema formation. Challenges to brain-cell volume homeostasis can have dramatic consequences, given the fixed volume of the rigid skull and the effect of swelling on secondary neuronal injury. With even small changes in cellular and extracellular volume, cerebral edema can compromise regional or global cerebral blood flow and metabolism or result in compression of vital brain structures. Osmotherapy has been the mainstay of pharmacologic therapy and is typically administered as part of an escalating medical treatment algorithm that can include corticosteroids, diuretics, and pharmacological cerebral metabolic suppression. Novel treatment targets for cerebral edema include the Na(+)-K(+)-2Cl(-) co-transporter (NKCC1) and the SUR1-regulated NC(Ca-ATP) (SUR1/TRPM4) channel. These two ion channels have been demonstrated to be critical mediators of edema formation in brain-injured states. Their specific inhibitors, bumetanide and glibenclamide, respectively, are well-characterized Food and Drug Administration-approved drugs with excellent safety profiles. Directed inhibition of these ion transporters has the potential to reduce the development of cerebral edema and is currently being investigated in human clinical trials. Another class of treatment agents for cerebral edema is vasopressin receptor antagonists. Euvolemic hyponatremia is present in a myriad of neurological conditions resulting in cerebral edema. A specific antagonist of the vasopressin V1A- and V2-receptor, conivaptan, promotes water excretion while sparing electrolytes through a process known as aquaresis.
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Affiliation(s)
- Brian P. Walcott
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Kristopher T. Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201 USA
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Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab 2011; 31:17-35. [PMID: 21045864 PMCID: PMC3049472 DOI: 10.1038/jcbfm.2010.191] [Citation(s) in RCA: 544] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/01/2010] [Accepted: 10/01/2010] [Indexed: 01/01/2023]
Abstract
Cortical spreading depression (CSD) and depolarization waves are associated with dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells, increased energy metabolism and changes in cerebral blood flow (CBF). There is strong clinical and experimental evidence to suggest that CSD is involved in the mechanism of migraine, stroke, subarachnoid hemorrhage and traumatic brain injury. The implications of these findings are widespread and suggest that intrinsic brain mechanisms have the potential to worsen the outcome of cerebrovascular episodes or brain trauma. The consequences of these intrinsic mechanisms are intimately linked to the composition of the brain extracellular microenvironment and to the level of brain perfusion and in consequence brain energy supply. This paper summarizes the evidence provided by novel invasive techniques, which implicates CSD as a pathophysiological mechanism for this group of acute neurological disorders. The findings have implications for monitoring and treatment of patients with acute brain disorders in the intensive care unit. Drawing on the large body of experimental findings from animal studies of CSD obtained during decades we suggest treatment strategies, which may be used to prevent or attenuate secondary neuronal damage in acutely injured human brain cortex caused by depolarization waves.
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Affiliation(s)
- Martin Lauritzen
- Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark.
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39
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Jüttler E, Hacke W. Cerebral Infarction. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yao X, Miao W, Li M, Wang M, Ma J, Wang Y, Miao L, Feng H. Protective effect of albumin on VEGF and brain edema in acute ischemia in rats. Neurosci Lett 2010; 472:179-83. [DOI: 10.1016/j.neulet.2010.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 01/20/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Clark DL, Penner M, Wowk S, Orellana-Jordan I, Colbourne F. Treatments (12 and 48 h) with systemic and brain-selective hypothermia techniques after permanent focal cerebral ischemia in rat. Exp Neurol 2009; 220:391-9. [DOI: 10.1016/j.expneurol.2009.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/21/2009] [Accepted: 10/03/2009] [Indexed: 10/20/2022]
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Gerriets T, Walberer M, Ritschel N, Tschernatsch M, Mueller C, Bachmann G, Schoenburg M, Kaps M, Nedelmann M. Edema formation in the hyperacute phase of ischemic stroke. Laboratory investigation. J Neurosurg 2009; 111:1036-42. [PMID: 19408985 DOI: 10.3171/2009.3.jns081040] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Brain edema formation is a serious complication of ischemic stroke and can lead to mechanical compression of adjacent brain structures, cerebral herniation, and death. Furthermore, the space-occupying effect of edema impairs regional cerebral blood flow (rCBF), which is particularly important in the penumbra phase of stroke. In the present study, the authors evaluated the natural course of edema formation in the hyperacute phase of focal cerebral ischemia. METHODS Middle cerebral artery occlusion (MCAO) or a sham procedure was performed in rats within an MR imaging unit (in-bore occlusion). Both pre- and postischemic images could be compared on a pixel-by-pixel basis. The T2 relaxation time (T2RT), a marker for brain water content, was measured in regions of interest. RESULTS A significant increase in the T2RT was detectable as early as 20-45 minutes after MCAO. At this early time point the midline shift (MLS) amounted to 0.214 +/- 0.092 cm in the MCAO group and 0.061 +/- 0.063 cm in the sham group (p < 0.007). The T2RT and MLS increased linearly thereafter. Evans blue dye was intravenously injected in additional animals 20 and 155 minutes after MCAO. Extravasation of the dye was visible in all animals, indicating increased permeability of the blood-brain barrier. CONCLUSIONS Vasogenic brain edema occurs much earlier than expected following permanent MCAO and leads to MLS and mechanical compression of adjacent brain structures. Since compression effects can impair rCBF, early edema formation can significantly contribute to infarct formation and thus represents a promising target for neuroprotection.
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Affiliation(s)
- Tibo Gerriets
- Department of Neurology, Justus Liebig-University Giessen, Giessen, Germany.
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Lourbopoulos A, Grigoriadis N, Karacostas D, Spandou E, Artemis N, Milonas I, Tascos N, Simeonidou C. Predictable ventricular shift after focal cerebral ischaemia in rats: practical considerations for intraventricular therapeutic interventions. Lab Anim 2009; 44:71-8. [PMID: 19900985 DOI: 10.1258/la.2009.009043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intracerebroventricular (ICV) route of administration is a useful experimental method to study the effects of chemicals or cellular grafts in the ventricular compartment of the brain after focal ischaemia. However, the induced oedema may cause structural dislocating phenomena and render a stereotaxic ICV invasion difficult and practically unavailable especially during the acute post-ischaemia phase. The aim of this study was to measure these structural ventricular dislocations and set new stereotaxic coordinates for successful and cost-effective ICV invasion 6-18 h after focal cerebral ischaemia. Wistar rats were subjected to 2 h middle cerebral artery occlussion (t-MCAO), were neurologically evaluated (modified Neurological Stroke Scale [mNSS], modified Bederson's Scale [mBS] and grid-walking test [GWT]) and brain slides were studied at 6 and 18 h post-occlusion for infarction volume, hemispheric oedema, middle line dislocation and stereotaxia of the lateral ventricles. Our data indicated that stereotaxic coordinates of the lateral ventricles in the infarcted and contralateral hemispheres significantly (P < 0.05) changed at both time-points and were linearly correlated with the mNSS, mBS and some GWT scores (P < 0.001). This correlation allowed for the calculation of simple (linear) mathematical equations (stereotaxic coordinate = b0 + b1*mNSS, where 'b0' and 'b1' are fixed number and factor, respectively, calculated by regression analysis) that determined individually new coordinates for each animal. Verification experiments revealed that the new coordinates render ICV invasion feasible in up to 80% of infarcted rats (number needed to treat 1.65), compared with only 19.4% using the classical coordinates for normal rats. Therefore, we propose a new, time- and cost-effective methodology for practically feasible ICV invasion in rats 6-18 h after t-MCAO.
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Affiliation(s)
- A Lourbopoulos
- B' Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece
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Abstract
Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity worldwide in individuals under the age of 45 years, and, despite extensive efforts to develop neuroprotective therapies, there has been no successful outcome in any trial of neuroprotection to date. In addition to recognizing that many TBI clinical trials have not been optimally designed to detect potential efficacy, the failures can be attributed largely to the fact that most of the therapies investigated have been targeted toward an individual injury factor. The contemporary view of TBI is that of a very heterogenous type of injury, one that varies widely in etiology, clinical presentation, severity, and pathophysiology. The mechanisms involved in neuronal cell death after TBI involve an interaction of acute and delayed anatomic, molecular, biochemical, and physiological events that are both complex and multifaceted. Accordingly, neuropharmacotherapies need to be targeted at the multiple injury factors that contribute to the secondary injury cascade, and, in so doing, maximize the likelihood of a successful outcome. This review focuses on a number of such multifunctional compounds that have shown considerable success in experimental studies and that show maximum promise for success in clinical trials.
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Affiliation(s)
- Robert Vink
- School of Medical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia.
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