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Klavansky D, Marquez DL, Vijayan M, Reynolds AS. Osmotic Demyelination Syndrome Associated with Uremia and Elevated Serum Osmolality. Neurocrit Care 2024; 40:1218-1222. [PMID: 38506970 DOI: 10.1007/s12028-024-01956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Dana Klavansky
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA.
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Destiny Lee Marquez
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhusudan Vijayan
- Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra S Reynolds
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Fainberg NA, Silver MR, Arena JD, Landzberg EI, Banwell B, Gambrah-Lyles C, Kirschen MP, Madsen PJ, McLendon L, Narula S, Tucker AM, Huh JW, Kienzle MF. Invasive Multimodality Neuromonitoring to Manage Cerebral Edema in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Crit Care Explor 2023; 5:e1003. [PMID: 37929184 PMCID: PMC10624473 DOI: 10.1097/cce.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory disorder of the CNS with a variety of clinical manifestations, including cerebral edema. Case Summary A 7-year-old boy presented with headaches, nausea, and somnolence. He was found to have cerebral edema that progressed to brainstem herniation. Invasive multimodality neuromonitoring was initiated to guide management of intracranial hypertension and cerebral hypoxia while he received empiric therapies for neuroinflammation. Workup revealed serum myelin oligodendrocyte glycoprotein antibodies. He survived with a favorable neurologic outcome. Conclusion We describe a child who presented with cerebral edema and was ultimately diagnosed with MOGAD. Much of his management was guided using data from invasive multimodality neuromonitoring. Invasive multimodality neuromonitoring may have utility in managing life-threatening cerebral edema due to neuroinflammation.
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Affiliation(s)
- Nina A Fainberg
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Maya R Silver
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - John D Arena
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Elizabeth I Landzberg
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Claudia Gambrah-Lyles
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew P Kirschen
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Peter J Madsen
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Loren McLendon
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, FL
- Division of Pediatric Neurology, Nemours Children's Health, Jacksonville, FL
| | - Sona Narula
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alexander M Tucker
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jimmy W Huh
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Martha F Kienzle
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Udzik J, Pacholewicz J, Biskupski A, Walerowicz P, Januszkiewicz K, Kwiatkowska E. Alterations to Kidney Physiology during Cardiopulmonary Bypass-A Narrative Review of the Literature and Practical Remarks. J Clin Med 2023; 12:6894. [PMID: 37959359 PMCID: PMC10647422 DOI: 10.3390/jcm12216894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20-50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. CONCLUSIONS Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. FUTURE DIRECTIONS The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.
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Affiliation(s)
- Jakub Udzik
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Jerzy Pacholewicz
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Andrzej Biskupski
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Paweł Walerowicz
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Kornelia Januszkiewicz
- Department of Anesthesiology, Intensive Care and Acute Intoxications, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Ewa Kwiatkowska
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland;
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Hu F, Zhu J, Zhang S, Wang C, Zhang L, Zhou H, Shi H. A predictive model for the risk of sepsis within 30 days of admission in patients with traumatic brain injury in the intensive care unit: a retrospective analysis based on MIMIC-IV database. Eur J Med Res 2023; 28:290. [PMID: 37596695 PMCID: PMC10436454 DOI: 10.1186/s40001-023-01255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/30/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Traumatic brain injury (TBI) patients admitted to the intensive care unit (ICU) are at a high risk of infection and sepsis. However, there are few studies on predicting secondary sepsis in TBI patients in the ICU. This study aimed to build a prediction model for the risk of secondary sepsis in TBI patients in the ICU, and provide effective information for clinical diagnosis and treatment. METHODS Using the MIMIC IV database version 2.0 (Medical Information Mart for Intensive Care IV), we searched data on TBI patients admitted to ICU and considered them as a study cohort. The extracted data included patient demographic information, laboratory indicators, complications, and other clinical data. The study cohort was divided into a training cohort and a validation cohort. In the training cohort, variables were screened by LASSO (Least absolute shrinkage and selection operator) regression and stepwise Logistic regression to assess the predictive ability of each feature on the incidence of patients. The screened variables were included in the final Logistic regression model. Finally, the decision curve, calibration curve, and receiver operating character (ROC) were used to test the performance of the model. RESULTS Finally, a total of 1167 patients were included in the study, and these patients were randomly divided into the training (N = 817) and validation (N = 350) cohorts at a ratio of 7:3. In the training cohort, seven features were identified as key predictors of secondary sepsis in TBI patients in the ICU, including acute kidney injury (AKI), anemia, invasive ventilation, GCS (Glasgow Coma Scale) score, lactic acid, and blood calcium level, which were included in the final model. The areas under the ROC curve in the training cohort and the validation cohort were 0.756 and 0.711, respectively. The calibration curve and ROC curve show that the model has favorable predictive accuracy, while the decision curve shows that the model has favorable clinical benefits with good and robust predictive efficiency. CONCLUSION We have developed a nomogram model for predicting secondary sepsis in TBI patients admitted to the ICU, which can provide useful predictive information for clinical decision-making.
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Affiliation(s)
- Fangqi Hu
- Department of Neurosurgery, Lianyungang Clinical Medical College, Nanjing Medical University, Lianyungang, 222000, Jiangsu, China
| | - Jiaqiu Zhu
- Department of Neurosurgery, The Second People's Hospital of Lianyungang City, Lianyungang, 222000, Jiangsu, China
| | - Sheng Zhang
- Department of Neurosurgery, Huzhou Central Hospital, Huzhou, 313000, Zhejiang, China
| | - Cheng Wang
- Department of Neurosurgery, Lianyungang Clinical Medical College, Nanjing Medical University, Lianyungang, 222000, Jiangsu, China
| | - Liangjia Zhang
- Department of Neurosurgery, Lianyungang Clinical Medical College, Nanjing Medical University, Lianyungang, 222000, Jiangsu, China
| | - Hui Zhou
- Department of Neurosurgery, Lianyungang Clinical Medical College, Nanjing Medical University, Lianyungang, 222000, Jiangsu, China.
| | - Hui Shi
- Department of Neurosurgery, Lianyungang Clinical Medical College, Nanjing Medical University, Lianyungang, 222000, Jiangsu, China
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Wang Y, Zhu Y, Wang J, Dong L, Liu S, Li S, Wu Q. Purinergic signaling: A gatekeeper of blood-brain barrier permeation. Front Pharmacol 2023; 14:1112758. [PMID: 36825149 PMCID: PMC9941648 DOI: 10.3389/fphar.2023.1112758] [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: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
This review outlined evidence that purinergic signaling is involved in the modulation of blood-brain barrier (BBB) permeability. The functional and structural integrity of the BBB is critical for maintaining the homeostasis of the brain microenvironment. BBB integrity is maintained primarily by endothelial cells and basement membrane but also be regulated by pericytes, neurons, astrocytes, microglia and oligodendrocytes. In this review, we summarized the purinergic receptors and nucleotidases expressed on BBB cells and focused on the regulation of BBB permeability by purinergic signaling. The permeability of BBB is regulated by a series of purinergic receptors classified as P2Y1, P2Y4, P2Y12, P2X4, P2X7, A1, A2A, A2B, and A3, which serve as targets for endogenous ATP, ADP, or adenosine. P2Y1 and P2Y4 antagonists could attenuate BBB damage. In contrast, P2Y12-mediated chemotaxis of microglial cell processes is necessary for rapid closure of the BBB after BBB breakdown. Antagonists of P2X4 and P2X7 inhibit the activation of these receptors, reduce the release of interleukin-1 beta (IL-1β), and promote the function of BBB closure. In addition, the CD39/CD73 nucleotidase axis participates in extracellular adenosine metabolism and promotes BBB permeability through A1 and A2A on BBB cells. Furthermore, A2B and A3 receptor agonists protect BBB integrity. Thus, the regulation of the BBB by purinergic signaling is complex and affects the opening and closing of the BBB through different pathways. Appropriate selective agonists/antagonists of purinergic receptors and corresponding enzyme inhibitors could modulate the permeability of the BBB, effectively delivering therapeutic drugs/cells to the central nervous system (CNS) or limiting the entry of inflammatory immune cells into the brain and re-establishing CNS homeostasis.
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Affiliation(s)
| | | | - Junmeng Wang
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Longcong Dong
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuqing Liu
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Sihui Li
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Barea-Mendoza JA, Chico-Fernández M, Quintana-Díaz M, Serviá-Goixart L, Fernández-Cuervo A, Bringas-Bollada M, Ballesteros-Sanz MÁ, García-Sáez Í, Pérez-Bárcena J, Llompart-Pou JA. Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors. J Clin Med 2022; 11:jcm11237216. [PMID: 36498789 PMCID: PMC9739137 DOI: 10.3390/jcm11237216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28029 Madrid, Spain
| | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain
| | - Ana Fernández-Cuervo
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - María Bringas-Bollada
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | | | - Íker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, 20014 Donostia, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Correspondence:
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Cenhrang K, Robart L, Castiaux AD, Martin RS. 3D printed devices with integrated collagen scaffolds for cell culture studies including transepithelial/transendothelial electrical resistance (TEER) measurements. Anal Chim Acta 2022; 1221:340166. [PMID: 35934386 PMCID: PMC9511703 DOI: 10.1016/j.aca.2022.340166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/01/2022]
Abstract
In this paper, we describe the use of 3D printed devices for both static and flow studies that contain electrospun collagen scaffolds and can accommodate transepithelial/transendothelial electrical resistance (TEER) measurements. Electrospinning was used to create the collagen scaffold, followed by an optimized 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide/N-Hydroxysuccinimide (EDC/NHS) cross-linking procedure to produce stable collagen fibers that are similar in size to fibers in vivo. LC/MS was used to study the leaching of solvent and NHS from the scaffold, with several rinsing steps being shown to eliminate the leaching and promote the culture of Madin-Darby Canine Kidney (MDCK) epithelial cells on the scaffold. Both static and flow 2-part devices were successfully fabricated by 3D printing using either VeroClear or MED610 material (PolyJet printing) and assembling the scaffold between laser cut Teflon gaskets. The devices were designed to easily accommodate commonly used STX2 chopstick electrodes for TEER measurements. A detailed comparison was made between the use of collagen scaffolds vs other electrospun materials for cell culture. The collagen extracellular matrix model displayed a high barrier functionality for up to 7 days. In addition, a different 3D printed device with a collagen scaffold is described to incorporate continuous flow and replenishment of media under the cell layer in a manner that also enables periodic recording of TEER measurements. Overall, this work shows that the combination of biological ECM materials such as collagen into microfluidic devices that incorporate flow have great potential to form more realistic cell culture models in areas such as blood brain barrier research.
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Affiliation(s)
| | - Logan Robart
- Department of Chemistry, Saint Louis University, USA
| | - Andre D Castiaux
- Department of Chemistry, Saint Louis University, USA; Center for Additive Manufacturing, Saint Louis University, USA
| | - R Scott Martin
- Department of Chemistry, Saint Louis University, USA; Center for Additive Manufacturing, Saint Louis University, USA.
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Arel E, Rolland L, Thireau J, Torrente AG, Bechard E, Bride J, Jopling C, Demion M, Le Guennec JY. The Effect of Hypothermia and Osmotic Shock on the Electrocardiogram of Adult Zebrafish. BIOLOGY 2022; 11:biology11040603. [PMID: 35453802 PMCID: PMC9025276 DOI: 10.3390/biology11040603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Assessing cardiac toxicity of new drugs is a requirement for their approval. One of the parameters which is carefully looked at is the QT interval, which is determined using an electrocardiogram (ECG). Before undertaking clinical trials using human patients, it is important to first perform pre-clinical tests using animal models. Zebrafish are widely used to study cardiac physiology and several reports suggest that although ECG measurement can be performed, the recording configuration appears to affect the results. Our research aimed to provide a comprehensive characterization of adult zebrafish ECG to determine the best practice for using this model during cardiac toxicity trials. We tested three recording configurations and determined that exposing the heart provided the most reliable and reproducible ECG recordings. We also determined the most accurate correction to apply to calculate the corrected QT, which makes the QT interval independent of the heart rate, a critical parameter when assessing drug cardiac toxicity. Overall, our study highlights the best conditions to record zebrafish ECG and demonstrates their utility for cardiac toxicity testing. Abstract The use of zebrafish to explore cardiac physiology has been widely adopted within the scientific community. Whether this animal model can be used to determine drug cardiac toxicity via electrocardiogram (ECG) analysis is still an ongoing question. Several reports indicate that the recording configuration severely affects the ECG waveforms and its derived-parameters, emphasizing the need for improved characterization. To address this problem, we recorded ECGs from adult zebrafish hearts in three different configurations (unexposed heart, exposed heart, and extracted heart) to identify the most reliable method to explore ECG recordings at baseline and in response to commonly used clinical therapies. We found that the exposed heart configuration provided the most reliable and reproducible ECG recordings of waveforms and intervals. We were unable to determine T wave morphology in unexposed hearts. In extracted hearts, ECG intervals were lengthened and P waves were unstable. However, in the exposed heart configuration, we were able to reliably record ECGs and subsequently establish the QT-RR relationship (Holzgrefe correction) in response to changes in heart rate.
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Affiliation(s)
- Elodie Arel
- PhyMedExp, Université de Montpellier, Inserm U1046, UMR CNRS 9412, 34090 Montpellier, France; (E.A.); (J.T.); (E.B.); (J.B.); (M.D.); (J.-Y.L.G.)
- Institut de génomique fonctionnelle (IGF), Université de Montpellier, Inserm U1191, UMR CNRS 5203, 34094 Montpellier, France; (L.R.); (A.G.T.)
| | - Laura Rolland
- Institut de génomique fonctionnelle (IGF), Université de Montpellier, Inserm U1191, UMR CNRS 5203, 34094 Montpellier, France; (L.R.); (A.G.T.)
| | - Jérôme Thireau
- PhyMedExp, Université de Montpellier, Inserm U1046, UMR CNRS 9412, 34090 Montpellier, France; (E.A.); (J.T.); (E.B.); (J.B.); (M.D.); (J.-Y.L.G.)
| | - Angelo Giovanni Torrente
- Institut de génomique fonctionnelle (IGF), Université de Montpellier, Inserm U1191, UMR CNRS 5203, 34094 Montpellier, France; (L.R.); (A.G.T.)
| | - Emilie Bechard
- PhyMedExp, Université de Montpellier, Inserm U1046, UMR CNRS 9412, 34090 Montpellier, France; (E.A.); (J.T.); (E.B.); (J.B.); (M.D.); (J.-Y.L.G.)
| | - Jamie Bride
- PhyMedExp, Université de Montpellier, Inserm U1046, UMR CNRS 9412, 34090 Montpellier, France; (E.A.); (J.T.); (E.B.); (J.B.); (M.D.); (J.-Y.L.G.)
- Institut de génomique fonctionnelle (IGF), Université de Montpellier, Inserm U1191, UMR CNRS 5203, 34094 Montpellier, France; (L.R.); (A.G.T.)
| | - Chris Jopling
- Institut de génomique fonctionnelle (IGF), Université de Montpellier, Inserm U1191, UMR CNRS 5203, 34094 Montpellier, France; (L.R.); (A.G.T.)
- Correspondence:
| | - Marie Demion
- PhyMedExp, Université de Montpellier, Inserm U1046, UMR CNRS 9412, 34090 Montpellier, France; (E.A.); (J.T.); (E.B.); (J.B.); (M.D.); (J.-Y.L.G.)
| | - Jean-Yves Le Guennec
- PhyMedExp, Université de Montpellier, Inserm U1046, UMR CNRS 9412, 34090 Montpellier, France; (E.A.); (J.T.); (E.B.); (J.B.); (M.D.); (J.-Y.L.G.)
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Achar A, Myers R, Ghosh C. Drug Delivery Challenges in Brain Disorders across the Blood-Brain Barrier: Novel Methods and Future Considerations for Improved Therapy. Biomedicines 2021; 9:1834. [PMID: 34944650 PMCID: PMC8698904 DOI: 10.3390/biomedicines9121834] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
Due to the physiological and structural properties of the blood-brain barrier (BBB), the delivery of drugs to the brain poses a unique challenge in patients with central nervous system (CNS) disorders. Several strategies have been investigated to circumvent the barrier for CNS therapeutics such as in epilepsy, stroke, brain cancer and traumatic brain injury. In this review, we summarize current and novel routes of drug interventions, discuss pharmacokinetics and pharmacodynamics at the neurovascular interface, and propose additional factors that may influence drug delivery. At present, both technological and mechanistic tools are devised to assist in overcoming the BBB for more efficient and improved drug bioavailability in the treatment of clinically devastating brain disorders.
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Affiliation(s)
- Aneesha Achar
- Cerebrovascular Research, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (R.M.)
| | - Rosemary Myers
- Cerebrovascular Research, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (R.M.)
| | - Chaitali Ghosh
- Cerebrovascular Research, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (R.M.)
- Department of Biomedical Engineering and Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
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