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Ikeda T, Kawabori M, Zheng Y, Yamaguchi S, Gotoh S, Nakahara Y, Yoshie E, Fujimura M. Intranasal Administration of Mesenchymal Stem Cell-Derived Exosome Alleviates Hypoxic-Ischemic Brain Injury. Pharmaceutics 2024; 16:446. [PMID: 38675108 PMCID: PMC11053690 DOI: 10.3390/pharmaceutics16040446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Hypoxic-ischemic brain injury arises from inadequate oxygen delivery to the brain, commonly occurring following cardiac arrest, which lacks effective treatments. Recent studies have demonstrated the therapeutic potential of exosomes released from mesenchymal stem cells. Given the challenge of systemic dilution associated with intravenous administration, intranasal delivery has emerged as a promising approach. In this study, we investigate the effects of intranasally administered exosomes in an animal model. Exosomes were isolated from the cell supernatants using the ultracentrifugation method. Brain injury was induced in Sprague-Dawley rats through a transient four-vessel occlusion model. Intranasal administration was conducted with 3 × 108 exosome particles in 20 µL of PBS or PBS alone, administered daily for 7 days post-injury. Long-term cognitive behavioral assessments, biodistribution of exosomes, and histological evaluations of apoptosis and neuroinflammation were conducted. Exosomes were primarily detected in the olfactory bulb one hour after intranasal administration, subsequently distributing to the striatum and midbrain. Rats treated with exosomes exhibited substantial improvement in cognitive function up to 28 days after the insult, and demonstrated significantly fewer apoptotic cells along with higher neuronal cell survival in the hippocampus. Exosomes were found to be taken up by microglia, leading to a decrease in the expression of cytotoxic inflammatory markers.
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Affiliation(s)
- Takuma Ikeda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Yuyuan Zheng
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Sho Yamaguchi
- Regenerative Medicine and Cell Therapy Laboratories, Kaneka, Kobe 650-0047, Hyogo, Japan;
| | - Shuho Gotoh
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Yo Nakahara
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Erika Yoshie
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
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Wu Q, Wang GN, Hu H, Chen XF, Xu XQ, Zhang JS, Wu FY. A resting-state functional magnetic resonance imaging study of altered functional brain activity in cardiac arrest survivors with good neurological outcome. Front Neurol 2023; 14:1136197. [PMID: 37153675 PMCID: PMC10157780 DOI: 10.3389/fneur.2023.1136197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Abstract
Purpose To investigate the spontaneous brain activity alterations in survivors of cardiac arrest (CA) with good neurological outcome using resting-state functional magnetic resonance imaging (rs-fMRI) with amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) methods. Materials and methods Thirteen CA survivors with favorable neurological outcomes and 13 healthy controls (HCs) were recruited and underwent rs-fMRI scans. The ALFF and ReHo methods were applied to assess the regional intensity and synchronization of spontaneous brain activity. Correlation analyses were performed to explore the relationships between the mean ALFF and ReHo values in significant clusters and clinical parameters. Results The survivors of CA showed significantly decreased ALFF values in the left postcentral gyrus and precentral gyrus and increased ALFF values in the left hippocampus and parahippocampal gyrus than HCs. Significantly decreased ReHo values were observed in the left inferior occipital gyrus and middle occipital gyrus in the patients. Mean ALFF values in the left hippocampus and parahippocampal gyrus were positively correlated with the time to return of spontaneous circulation (r = 0.794, p = 0.006) in the patient group. Conclusion Functional activity alterations in the brain areas corresponding to known cognitive and physical impairments were observed in CA survivors with preserved neurological function. Our results could advance the understanding of the neurological mechanisms underlying the residual deficits in those patients.
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Affiliation(s)
- Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gan-Nan Wang
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xu-Feng Chen
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Fei-Yun Wu, , Jin-Song Zhang, , Xu-Feng Chen,
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Song Zhang
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Fei-Yun Wu, , Jin-Song Zhang, , Xu-Feng Chen,
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Fei-Yun Wu, , Jin-Song Zhang, , Xu-Feng Chen,
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Zook N, Voss S, Blennow Nordström E, Brett SJ, Jenkinson E, Shaw P, White P, Benger J. Neurocognitive function following out-of-hospital cardiac arrest: A systematic review. Resuscitation 2021; 170:238-246. [PMID: 34648921 DOI: 10.1016/j.resuscitation.2021.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/28/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The primary aim of this review was to investigate neurocognitive outcomes following out-of-hospital cardiac arrest (OHCA). Specifically, the focus was on identifying the different neurocognitive domains that are assessed, the measures used, and the level of, and criteria for, impairment. DESIGN AND REVIEW METHODS A systematic review of the literature from 2006 to 2021 was completed using Medline, Cinahl and Psychinfo. Criteria for inclusion were studies with participants over the age of 18, OHCA and at least one neurocognitive function measure. Qualitative and case studies were excluded. Reviewers assessed criteria and risk of bias using a modified version of Downs and Black. RESULTS Forty-three studies were identified. Most studies had a low risk of bias (n = 31) or moderate risk of bias (n = 11) and one had a high risk; however, only six reported effect sizes or power analyses. Multiple measures of neurocognitive outcomes were used (>50) and level of impairment criteria varied considerably. Memory impairments were frequently found and were also more likely to be impaired followed by executive function and processing speed. DISCUSSION This review highlights the heterogeneity of measures and approaches used to assess neurocognitive outcomes following OHCA as well as the need to improve risk of bias concerning generalizability. Improved understanding of the approaches used for assessment and the subsequent findings will facilitate a standardized evaluation of neurocognitive outcomes following OHCA.
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Affiliation(s)
- Nancy Zook
- Health and Applied Sciences, University of the West of England, Bristol, UK.
| | - Sarah Voss
- Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Erik Blennow Nordström
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Pauline Shaw
- Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Paul White
- Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jonathan Benger
- Health and Applied Sciences, University of the West of England, Bristol, UK
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Agarwal S, Melmed K, Dogra S, Jain R, Conway J, Galetta S, Lewis A. Increase in Ventricle Size and the Evolution of White Matter Changes on Serial Imaging in Critically Ill Patients with COVID-19. Neurocrit Care 2021; 35:491-500. [PMID: 33674942 PMCID: PMC7935478 DOI: 10.1007/s12028-021-01207-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Evolution of brain magnetic resonance imaging (MRI) findings in critically ill patients with coronavirus disease 2019 (COVID-19) is unknown. METHODS We retrospectively reviewed 4530 critically ill patients with COVID-19 admitted to three tertiary care hospitals in New York City from March 1 to June 30, 2020 to identify patients who had more than one brain MRI. We reviewed the initial and final MRI for each patient to (1) measure the percent change in the bicaudate index and third ventricular diameter and (2) evaluate changes in the presence and severity of white matter changes. RESULTS Twenty-one patients had two MRIs separated by a median of 22 [Interquartile range (IQR) 14-30] days. Ventricle size increased for 15 patients (71%) between scans [median bicaudate index 0.16 (IQR 0.126-0.181) initially and 0.167 (IQR 0.138-0.203) on final imaging (p < 0.001); median third ventricular diameter 6.9 mm (IQR 5.4-10.3) initially and 7.2 mm (IQR 6.4-10.8) on final imaging (p < 0.001)]. Every patient had white matter changes on the initial and final MRI; between images, they worsened for seven patients (33%) and improved for three (14%). CONCLUSIONS On serial imaging of critically ill patients with COVID-19, ventricle size frequently increased over several weeks. White matter changes were often unchanged, but in some cases they worsened or improved, demonstrating there is likely a spectrum of pathophysiological processes responsible for these changes.
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Affiliation(s)
- Shashank Agarwal
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016 USA
| | - Kara Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016 USA ,Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016 USA
| | - Siddhant Dogra
- Department of Radiology, NYU Langone Medical Center, New York, NY 10016 USA
| | - Rajan Jain
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016 USA ,Department of Radiology, NYU Langone Medical Center, New York, NY 10016 USA
| | - Jenna Conway
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016 USA
| | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016 USA ,Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016 USA
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016 USA ,Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016 USA
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