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Abstract
The brain is a complex organ, fundamentally changing across the day to perform basic functions like sleep, thought, and regulating whole-body physiology. This requires a complex symphony of nutrients, hormones, ions, neurotransmitters and more to be properly distributed across the brain to maintain homeostasis throughout 24 hours. These solutes are distributed both by the blood and by cerebrospinal fluid. Cerebrospinal fluid contents are distinct from the general circulation because of regulation at brain barriers including the choroid plexus, glymphatic system, and blood-brain barrier. In this review, we discuss the overlapping circadian (≈24-hour) rhythms in brain fluid biology and at the brain barriers. Our goal is for the reader to gain both a fundamental understanding of brain barriers alongside an understanding of the interactions between these fluids and the circadian timing system. Ultimately, this review will provide new insight into how alterations in these finely tuned clocks may lead to pathology.
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Affiliation(s)
- Velia S Vizcarra
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ryann M Fame
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Lauren M Hablitz
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Kuo LT, Lu HY, Chen YH. Traumatic brain injury-induced disruption of the circadian clock. J Mol Med (Berl) 2024; 102:403-414. [PMID: 38285094 PMCID: PMC10879350 DOI: 10.1007/s00109-024-02416-w] [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: 02/22/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
Disturbances in the circadian rhythm have been reported in patients following traumatic brain injury (TBI). However, the rhythmic expression of circadian genes in peripheral blood leukocytes (PBL) following TBI has not yet been studied. The messenger ribonucleic acid (mRNA) expression of period 1 (Per1), Per2, Per3, cryptochrome 1 (Cry1), Cry2, brain and muscle aryl hydrocarbon receptor nuclear translocator-like 1 (Bmal1), and circadian locomotor output cycles kaput (Clock) was quantified in PBLs from sham-operated rats and rats with acute subdural hematoma (ASDH) over a 48-h period. The rectal temperature of the animals was measured every 4 h over 2 days. The mesor, rhythm, amplitude, and acrophase were estimated using cosinor analysis. Cosinor analysis revealed that Per2, Cry1, and Bmal1 mRNAs were rhythmically expressed in the PBLs of sham-operated rats. In contrast, fluctuations in rhythmic expression were not observed following ASDH. The rectal temperature of sham-operated rats also exhibited rhythmicity. ASDH rats had a disrupted rectal temperature rhythm, a diminished amplitude, and an acrophase shift. TBI with ASDH results in dysregulated expression of some circadian genes and changes in body temperature rhythm. Further research is required to understand the pathophysiology of altered circadian networks following TBI. KEY MESSAGES: First to investigate the mRNA expression of circadian genes in PBLs of ASDH rats. ASDH rats had disrupted rhythmicity of Per2, Cry1, and Bmal1 mRNA expression. Cosinor analysis showed that ASDH rats had a disrupted rectal temperature rhythm.
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Affiliation(s)
- Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 100, Taiwan.
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Douliu, Yunlin, 640, Taiwan.
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Yunlin, 640, Taiwan
| | - Yi-Hsing Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 100, Taiwan
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Shibukawa S, Konta N, Niwa T, Miyati T, Yonemochi T, Yoshimaru D, Horie T, Kuroda K, Sorimachi T. Temperature measurement of intracranial cerebrospinal fluid using diffusion tensor imaging after revascularization surgery in Moyamoya disease. Magn Reson Imaging 2023; 99:1-6. [PMID: 36608908 DOI: 10.1016/j.mri.2022.12.027] [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: 10/10/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Brain temperature monitoring using a catheter thermometer has been reported to be a useful technique to predict prognosis in neurosurgery. To investigate the possibility of measuring intracranial cerebrospinal fluid temperature for postoperative monitoring in patients with Moyamoya disease (MMD) after bypass surgery. MATERIALS AND METHODS This study evaluated fifteen patients with MMD who were indicated for bypass surgery. Diffusion tensor imaging for brain thermometry were performed on a 1.5-T MR scanner. Intracranial cerebrospinal fluid temperature with/without considering the fractional anisotropy component, body temperature, C-reactive protein levels, white blood cell count, and cerebral blood flow measured by 123I-IMP single-photon emission computed tomography were obtained before surgery and 1-3 days after surgery. Pixel values considered to be signal outliers in fractional anisotropy processing were defined as cerebrospinal fluid noise index and calculated. Wilcoxon signed-rank test and effect size were performed to compare the changes before and after revascularization. Spearman's rho correlation coefficient was used to analyze the correlations between each parameter. Statistical significance was defined as p < 0.05. RESULTS All parameter values became significantly higher compared to those measured before revascularization (p < 0.01 in all cases). The effect sizes were largest for the cerebrospinal fluid temperature with fractional anisotropy processing and for C-reactive protein levels (Rank-biserial correlation = 1.0). The cerebrospinal fluid noise index and cerebrospinal fluid temperatures with fractional anisotropy processing (r = 0.84, p < 0.0001) or without fractional anisotropy processing (r = 0.95, p < 0.0001) showed highly significant positive correlations. Although no significant correlation was observed, cerebrospinal fluid temperatures with fractional anisotropy had small or moderately positive correlations with cerebral blood flow, body temperature, C-reactive protein levels, and white blood cell count (r = 0.37, 0.42, 0.41, and 0.44, respectively; p > 0.05). CONCLUSION Our findings suggest the possibility of postoperative monitoring for MMD patients by measuring intracranial cerebrospinal fluid temperature with fractional anisotropy processing. Intracranial cerebrospinal fluid temperature might be considered as combined response since cerebrospinal fluid, body temperature, and inflammation are equally correlated.
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Affiliation(s)
- Shuhei Shibukawa
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Tokyo, Japan; Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Meguro-ku, Tokyo, Japan; Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Natsuo Konta
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takuya Yonemochi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Yoshimaru
- Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; Jikei University School of Medicine, Division of Regenerative Medicine
| | - Tomohiko Horie
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Boots R, Xue G, Tromp D, Rawashdeh O, Bellapart J, Townsend S, Rudd M, Winter C, Mitchell G, Garner N, Clement P, Karamujic N, Zappala C. Circadian Rhythmicity of Vital Signs at Intensive Care Unit Discharge and Outcome of Traumatic Brain Injury. Am J Crit Care 2022; 31:472-482. [PMID: 36316179 DOI: 10.4037/ajcc2022821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Physiological functions with circadian rhythmicity are often disrupted during illness. OBJECTIVE To assess the utility of circadian rhythmicity of vital signs in predicting outcome of traumatic brain injury (TBI). METHODS A retrospective single-center cohort study of adult intensive care unit (ICU) patients with largely isolated TBI to explore the relationship between the circadian rhythmicity of vital signs during the last 24 hours before ICU discharge and clinical markers of TBI severity and score on the Glasgow Outcome Scale 6 months after injury (GOS-6). RESULTS The 130 study participants had a median age of 39.0 years (IQR, 23.0-59.0 years), a median Glasgow Coma Scale score at the scene of 8.0 (IQR, 3.0-13.0), and a median Rotterdam score on computed tomography of the head of 3 (IQR, 3-3), with 105 patients (80.8%) surviving to hospital discharge. Rhythmicity was present for heart rate (30.8% of patients), systolic blood pressure (26.2%), diastolic blood pressure (20.0%), and body temperature (26.9%). Independent predictors of a dichotomized GOS-6 ≥4 were the Rotterdam score (odds ratio [OR], 0.38 [95% CI, 0.18-0.81]; P = .01), Glasgow Coma Scale score at the scene (OR, 1.22 [95% CI, 1.05-1.41]; P = .008), age (OR, 0.95 [95% CI, 0.92-0.98]; P = .003), oxygen saturation <90% in the first 24 hours (OR, 0.19 [95% CI, 0.05-0.73]; P = .02), serum sodium level <130 mmol/L (OR, 0.20 [95% CI, 0.05-0.70]; P = .01), and active intracranial pressure management (OR, 0.16 [95% CI, 0.04-0.62]; P = .008), but not rhythmicity of any vital sign. CONCLUSION Circadian rhythmicity of vital signs at ICU discharge is not predictive of GOS-6 in patients with TBI.
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Affiliation(s)
- Rob Boots
- Rob Boots is an associate professor, Thoracic Medicine, Royal Brisbane and Women's Hospital, a senior specialist, Intensive Care, Bundaberg Hospital, Faculty of Medicine, The University of Queensland, Herston, and a professsor, Faculty of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - George Xue
- George Xue is the medical registrar, Royal Brisbane and Women's Hospital
| | - Dirk Tromp
- Dirk Tromp is the senior radiology registrar, Royal Brisbane and Women's Hospital
| | - Oliver Rawashdeh
- Oliver Rawashdeh is director, Chronobiology and Sleep Research, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Judith Bellapart
- Judith Bellapart is a senior specialist, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, and Burns, Trauma, and Critical Care, The University of Queensland
| | - Shane Townsend
- Shane Townsend is director, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Michael Rudd
- Michael Rudd is acting director, Trauma, Royal Brisbane and Women's Hospital
| | - Craig Winter
- Craig Winter is a staff specialist neurosurgeon, Royal Brisbane and Women's Hospital
| | - Gary Mitchell
- Gary Mitchell is a staff specialist, Emergency Medicine, Royal Brisbane and Women's Hospital
| | - Nicholas Garner
- Nicholas Garner is a PhD student, Chronobiology and Sleep Research Lab, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Pierre Clement
- Pierre Clement is a clinical information systems manager, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Nermin Karamujic
- Nermin Karamujic is a data manager and clinical information systems manager, Intensive Care Services, Royal Brisbane and Women's Hospital
| | - Christopher Zappala
- Christopher Zappala is a senior staff specialist, Thoracic Medicine, Royal Brisbane and Women's Hospital
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