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Grüter BE, Canzanella G, Hägler J, Rey J, Wanderer S, von Gunten M, Galvan JA, Grobholz R, Widmer HR, Remonda L, Andereggen L, Marbacher S. Topographic distribution of inflammation factors in a healing aneurysm. J Neuroinflammation 2023; 20:182. [PMID: 37533024 PMCID: PMC10394867 DOI: 10.1186/s12974-023-02863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Healing of intracranial aneurysms following endovascular treatment relies on the organization of early thrombus into mature scar tissue and neointima formation. Activation and deactivation of the inflammation cascade plays an important role in this process. In addition to timely evolution, its topographic distribution is hypothesized to be crucial for successful aneurysm healing. METHODS Decellularized saccular sidewall aneurysms were created in Lewis rats and coiled. At follow-up (after 3 days (n = 16); 7 days (n = 19); 21 days (n = 8)), aneurysms were harvested and assessed for healing status. In situ hybridization was performed for soluble inflammatory markers (IL6, MMP2, MMP9, TNF-α, FGF23, VEGF), and immunohistochemical analysis to visualize inflammatory cells (CD45, CD3, CD20, CD31, CD163, HLA-DR). These markers were specifically documented for five regions of interest: aneurysm neck, dome, neointima, thrombus, and adjacent vessel wall. RESULTS Coiled aneurysms showed enhanced patterns of thrombus organization and neointima formation, whereas those without treatment demonstrated heterogeneous patterns of thrombosis, thrombus recanalization, and aneurysm growth (p = 0.02). In coiled aneurysms, inflammation markers tended to accumulate inside the thrombus and in the neointima (p < 0.001). Endothelial cells accumulated directly in the neointima (p < 0.0001), and their presence was associated with complete aneurysm healing. CONCLUSION The presence of proinflammatory cells plays a crucial role in aneurysm remodeling after coiling. Whereas thrombus organization is hallmarked by a pronounced intra-thrombotic inflammatory reaction, neointima maturation is characterized by direct invasion of endothelial cells. Knowledge concerning topographic distribution of regenerative inflammatory processes may pave the way for future treatment modalities which enhance aneurysm healing after endovascular therapy.
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Affiliation(s)
- Basil E Grüter
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, C/o NeuroResearch Office,Tellstrasse 1, 5001, Aarau, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland.
| | - Gwendoline Canzanella
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Joshua Hägler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Jeannine Rey
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Michael von Gunten
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Institute of Pathology Laenggasse, Ittigen, Switzerland
| | - José A Galvan
- Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland
| | - Rainer Grobholz
- Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Hans-Rudolf Widmer
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, C/o NeuroResearch Office,Tellstrasse 1, 5001, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
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Hoch D, Rabaglio M, Grob T, von Gunten M, Beyer J, Akhoundova D. Exceptional Response to Pembrolizumab in a Mismatch Repair-Deficient Aggressive Prostate Cancer with Somatic EPCAM, MSH2, and MSH6 Co-Deletion: A Case Report. Case Rep Oncol 2023; 16:1280-1286. [PMID: 37928863 PMCID: PMC10622161 DOI: 10.1159/000534177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 11/07/2023] Open
Abstract
Mismatch repair-deficient (dMMR) prostate cancer (PCa) is a rare (1-5%) but highly actionable molecular subgroup of PCa, vulnerable to immune checkpoint inhibitors. Our case of sporadic dMMR PCa due to large monoallelic co-deletion of EPCAM, MSH2, and MSH6 features a clinically aggressive disease presentation and a major response to pembrolizumab. We report a 65-year-old patient with primary metastatic PCa, Gleason score 5 + 5 = 10, with penile and lymph node metastases at diagnosis. Patient showed rapid progression on first-line ADT and enzalutamide. Tumor next-generation sequencing (NGS) revealed microsatellite instability and a tumor mutational burden of 40.8 mutations/megabase. Immunohistochemistry showed co-loss of MSH2 and MSH6. Review of NGS row data confirmed large monoallelic deletion in chromosome 2p, including EPCAM, MSH2, and MSH6. No germline alterations in mismatch repair genes were detected. Patient showed excellent response to pembrolizumab, which is still ongoing. We conclude that early molecular tumor profiling is essential to enable personalized management of advanced PCa, especially in patients with aggressive or atypical disease course.
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Affiliation(s)
- Dennis Hoch
- Department of Medical Oncology and Hematology, University Hospital of Bern, Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology and Hematology, University Hospital of Bern, Bern, Switzerland
| | - Tobias Grob
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | | | - Jörg Beyer
- Department of Medical Oncology and Hematology, University Hospital of Bern, Bern, Switzerland
| | - Dilara Akhoundova
- Department of Medical Oncology and Hematology, University Hospital of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
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Wanderer S, Grüter BE, Kümin J, Boillat G, Sivanrupan S, Catalano K, von Gunten M, Widmer HR, Marbacher S, Andereggen L. Using a Cell-tracer Injection to Investigate the Origin of Neointima-forming Cells in a Rat Saccular Side Wall Model. J Vis Exp 2022. [DOI: 10.3791/63580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Wanderer S, Grüter BE, Strange F, Boillat G, Sivanrupan S, Rey J, von Gunten M, Remonda L, Widmer HR, Casoni D, Andereggen L, Fandino J, Marbacher S. Aspirin treatment prevents inflammation in experimental bifurcation aneurysms in New Zealand White rabbits. J Neurointerv Surg 2022; 14:189-195. [PMID: 33785639 PMCID: PMC8785064 DOI: 10.1136/neurintsurg-2020-017261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aneurysm wall degeneration is linked to growth and rupture. To address the effect of aspirin (ASA) on aneurysm formation under various wall conditions, this issue was analyzed in a novel rabbit bifurcation model. METHODS Bifurcation aneurysms created in 45 New Zealand White rabbits were randomized to vital (n=15), decellularized (n=13), or elastase-degraded (n=17) wall groups; each group was assigned to a study arm with or without ASA. At follow-up 28 days later, aneurysms were evaluated for patency, growth, and wall inflammation at macroscopic and histological levels. RESULTS 36 rabbits survived to follow-up at the end of the trial. None of the aneurysms had ruptured. Patency was visualized in all aneurysms by intraoperative fluorescence angiography and confirmed in 33 (92%) of 36 aneurysms by MRI/MRA. Aneurysm size was significantly increased in the vital (without ASA) and elastase-degraded (with and without ASA) groups. Aneurysm thrombosis was considered complete in three (50%) of six decellularized aneurysms without ASA by MRI/MRA. Locoregional inflammation of the aneurysm complex was significantly reduced in histological analysis among all groups treated with ASA. CONCLUSION ASA intake prevented inflammation of both the periadventitial tissue and aneurysm wall, irrespective of initial wall condition. Although ASA prevented significant growth in aneurysms with vital walls, this preventive effect did not have an important role in elastase-degraded pouches. In possible translation to the clinical situation, ASA might exert a potential preventive effect during early phases of aneurysm formation in patients with healthy vessels but not in those with highly degenerative aneurysm walls.
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Affiliation(s)
- Stefan Wanderer
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Basil Erwin Grüter
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Fabio Strange
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Gwendoline Boillat
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Sivani Sivanrupan
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Jeannine Rey
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | | | - Luca Remonda
- Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland
| | | | - Daniela Casoni
- Faculty of Medicine, University of Bern, Experimental Surgery Facility, Bern, Switzerland
| | - Lukas Andereggen
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Javier Fandino
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Serge Marbacher
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
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Zens P, Bello C, Scherz A, von Gunten M, Ochsenbein A, Schmid RA, Berezowska S. The effect of neoadjuvant therapy on PD-L1 expression and CD8+lymphocyte density in non-small cell lung cancer. Mod Pathol 2022; 35:1848-1859. [PMID: 35915139 PMCID: PMC9708547 DOI: 10.1038/s41379-022-01139-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
PD-L1 expression is the routine clinical biomarker for the selection of patients to receive immunotherapy in non-small cell lung cancer (NSCLC). However, the application and best timing of immunotherapy in the resectable setting is still under investigation. We aimed to study the effect of chemotherapy on PD-L1 expression and tumor infiltrating lymphocytes (TILs), which is to date still poorly understood. Our retrospective, single-centre neoadjuvant cohort comprised 96 consecutive patients with NSCLC resected 2000-2016 after neoadjuvant therapy, including paired diagnostic chemo-naïve specimens in 53 cases. A biologically matched surgical cohort of 114 primary resected cases was included. PD-L1 expression, CD8 + TILs density and tertiary lymphoid structures were assessed on whole slides and correlated with clinico-pathological characteristics and survival. Seven/53 and 12/53 cases had lower respectively higher PD-L1 expressions after neoadjuvant therapy. Most cases (n = 34) showed no changes in PD-L1 expression, the majority of these harboring PD-L1 < 1% in both samples (21/34 [61.8%]). Although CD8 + TILs density was significantly higher after chemotherapy (p = 0.031) in resections compared to diagnostic biopsies, this might be due to sampling and statistical bias. No difference in PD-L1 expression or CD8 + TILs density was detected when comparing the neoadjuvant and surgical cohort. In univariable analyses, higher CD8 + TILs density, higher numbers of tertiary lymphoid structures but not PD-L1 expression were significantly associated with longer survival. Increased PD-L1 expression after neoadjuvant chemotherapy was not significantly associated with shorter 5-year survival, but the number of cases was very low. In multivariable analysis, only pT category and age remained independent prognostic factors. In summary, PD-L1 expression was mostly unchanged after neoadjuvant chemotherapy compared to diagnostic biopsies. The sample size of cases with changed PD-L1 expression was too small to draw conclusions on any prognostic value.
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Affiliation(s)
- Philipp Zens
- grid.5734.50000 0001 0726 5157Institute of Pathology, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Corina Bello
- grid.5734.50000 0001 0726 5157Institute of Pathology, University of Bern, Bern, Switzerland ,Present Address: Department of Anesthesiology, Hospital Grabs, Spitalstrasse 44, CH-9472 Grabs, Switzerland
| | - Amina Scherz
- grid.411656.10000 0004 0479 0855Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Adrian Ochsenbein
- grid.411656.10000 0004 0479 0855Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ralph A. Schmid
- grid.411656.10000 0004 0479 0855Department of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, University of Bern, Bern, Switzerland. .,Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Croci DM, Wanderer S, Strange F, Grüter BE, Sivanrupan S, Andereggen L, Casoni D, von Gunten M, Widmer HR, Di Santo S, Fandino J, Mariani L, Marbacher S. Tocilizumab Reduces Vasospasms, Neuronal Cell Death, and Microclot Formation in a Rabbit Model of Subarachnoid Hemorrhage. Transl Stroke Res 2021; 12:894-904. [PMID: 33409731 DOI: 10.1007/s12975-020-00880-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/29/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023]
Abstract
Early brain injury (EBI), delayed cerebral vasospasm (DCVS), and delayed cerebral ischemia (DCI) are common complications of subarachnoid hemorrhage (SAH). Inflammatory processes in the cerebrospinal fluid (CSF) are one of the causes for such complications. Our aim to study the effects of an IL-6 receptor antagonist (Tocilizumab) examines the occurrence of DCVS, neuronal cell death, and microclot formation in an acute SAH rabbit model. Twenty-nine New Zealand white rabbits were randomized into one of three groups as the SAH, SAH + Tocilizumab, and sham groups. In SAH groups, hemorrhage was induced by extracranial-intracranial arterial blood shunting from the subclavian artery into the cisterna magna under intracranial pressure (ICP) monitoring. In the second group, Tocilizumab was given once intravenously 1 h after SAH induction. Digital subtraction angiography was performed, and CSF and blood were sampled before and after (day 3) SAH induction. IL-6 plasma and CSF levels were measured. TUNEL, FJB, NeuN, and caspase-3 immunostaining were used to assess cell apoptosis, neurodegeneration, and neuronal cell death, respectively. Microclot formation was detected by fibrinogen immunostaining. Between baseline and follow-up, there was a significant reduction of angiographic DCVS (p < 0.0001) in the Tocilizumab compared with the SAH group. Tocilizumab treatment resulted in decreased neuronal cell death in the hippocampus (p = 0.006), basal cortex (p = 0.001), and decreased microclot formation (p = 0.02). Tocilizumab reduced DCVS, neuronal cell death, and microclot formation in a rabbit SAH model, and could be a potential treatment to prevent DCVS and DCI in SAH patients.
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Affiliation(s)
- Davide M Croci
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland.
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Basil E Grüter
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Sivani Sivanrupan
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Daniela Casoni
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | | | - Hans Rudolf Widmer
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefano Di Santo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
- Cerebrovascular Research Group, Department of Biomedical Research, University of Bern, Bern, Switzerland
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Grüter BE, Wanderer S, Strange F, Boillat G, Täschler D, Rey J, Croci DM, Grandgirard D, Leib SL, von Gunten M, Di Santo S, Widmer HR, Remonda L, Andereggen L, Nevzati E, Coluccia D, Fandino J, Marbacher S. Patterns of Neointima Formation After Coil or Stent Treatment in a Rat Saccular Sidewall Aneurysm Model. Stroke 2021; 52:1043-1052. [PMID: 33504186 DOI: 10.1161/strokeaha.120.032255] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular aneurysm treatment relies on a biological process, including cell migration for thrombus organization and growth of a neointima. To better understand aneurysm healing, our study explores the origin of neointima-forming and thrombus-organizing cells in a rat saccular sidewall aneurysm model. METHODS Saccular aneurysms were transplanted onto the abdominal aorta of male Lewis rats and endovascularly treated with coils (n=28) or stents (n=26). In 34 cases, GFP+ (green fluorescent protein)-expressing vital aneurysms were sutured on wild-type rats, and in 23 cases, decellularized wild-type aneurysms were sutured on GFP+ rats. Follow-up at 3, 7, 14, 21, and 28 days evaluated aneurysms by fluorescence angiography, macroscopic inspection, and microscopy for healing and inflammation status. Furthermore, the origin of cells was tracked with fluorescence histology. RESULTS In animals with successful functional healing, histological studies showed a gradually advancing thrombus organization over time characterized by progressively growing neointima from the periphery of the aneurysm toward the center. Cell counts revealed similar distributions of GFP+ cells for coil or stent treatment in the aneurysm wall (54.4% versus 48.7%) and inside the thrombus (20.5% versus 20.2%) but significantly more GFP+ cells in the neointima of coiled (27.2 %) than stented aneurysms (10.4%; P=0.008). CONCLUSIONS Neointima formation and thrombus organization are concurrent processes during aneurysm healing. Thrombus-organizing cells originate predominantly in the parent artery. Neointima formation relies more on cell migration from the aneurysm wall in coiled aneurysms but receives greater contributions from cells originating in the parent artery in stent-treated aneurysms. Cell migration, which allows for a continuous endothelial lining along the parent artery's lumen, may be a prerequisite for complete aneurysm healing after endovascular therapy. In terms of translation into clinical practice, these findings may explain the variability in achieving complete aneurysm healing after coil treatment and the improved healing rate in stent-assisted coiling.
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Affiliation(s)
- Basil E Grüter
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Fabio Strange
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Gwendoline Boillat
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Dominik Täschler
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Jeannine Rey
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Davide M Croci
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Denis Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases (D.G., S.L.L.), University of Bern, Switzerland.,Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland
| | - Stephen L Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases (D.G., S.L.L.), University of Bern, Switzerland.,Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland
| | | | - Stefano Di Santo
- Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland.,Department of Neurosurgery, Bern University Hospital, Inselspital Bern, Switzerland (S.D.S., H.R.W.)
| | - Hans Rudolf Widmer
- Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland.,Department of Neurosurgery, Bern University Hospital, Inselspital Bern, Switzerland (S.D.S., H.R.W.)
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology (L.R.), Kantonsspital Aarau, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Daniel Coluccia
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
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Grüter BE, Wanderer S, Strange F, Sivanrupan S, von Gunten M, Widmer HR, Coluccia D, Andereggen L, Fandino J, Marbacher S. Comparison of Aneurysm Patency and Mural Inflammation in an Arterial Rabbit Sidewall and Bifurcation Aneurysm Model under Consideration of Different Wall Conditions. Brain Sci 2020; 10:brainsci10040197. [PMID: 32230757 PMCID: PMC7226569 DOI: 10.3390/brainsci10040197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/15/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Biological processes that lead to aneurysm formation, growth and rupture are insufficiently understood. Vessel wall inflammation and degeneration are suggested to be the driving factors. In this study, we aimed to investigate the natural course of vital (non-decellularized) and decellularized aneurysms in a rabbit sidewall and bifurcation model. Methods: Arterial pouches were sutured end-to-side on the carotid artery of New Zealand White rabbits (vital [n = 6] or decellularized [n = 6]), and into an end-to-side common carotid artery bifurcation (vital [n = 6] and decellularized [n = 6]). Patency was confirmed by fluorescence angiography. After 28 days, all animals underwent magnetic resonance and fluorescence angiography followed by aneurysm harvesting for macroscopic and histological evaluation. Results: None of the aneurysms ruptured during follow-up. All sidewall aneurysms thrombosed with histological inferior thrombus organization observed in decellularized compared to vital aneurysms. In the bifurcation model, half of all decellularized aneurysms thrombosed whereas the non-decellularized aneurysms remained patent with relevant increase in size compared to baseline. Conclusions: Poor thrombus organization in decellularized sidewall aneurysms confirmed the important role of mural cells in aneurysm healing after thrombus formation. Several factors such as restriction by neck tissue, small dimensions and hemodynamics may have prevented aneurysm growth despite pronounced inflammation in decellularized aneurysms. In the bifurcation model, rarefication of mural cells did not increase the risk of aneurysm growth but tendency to spontaneous thrombosis.
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Affiliation(s)
- Basil Erwin Grüter
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-62-838-41-41
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Sivani Sivanrupan
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | | | - Hans Rudolf Widmer
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inseslspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
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Grüter BE, Täschler D, Strange F, Rey J, von Gunten M, Grandgirard D, Leib SL, Remonda L, Widmer HR, Nevzati E, Fandino J, Marbacher S, Coluccia D. Testing bioresorbable stent feasibility in a rat aneurysm model. J Neurointerv Surg 2019; 11:1050-1054. [DOI: 10.1136/neurintsurg-2018-014697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/09/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
BackgroundAdvances in stent-assisted coiling have incrementally expanded endovascular treatment options for complex cerebral aneurysms. After successful coil consolidation and aneurysm occlusion, endovascular scaffolds are no longer needed. Thus, bioresorbable stents that disappear after aneurysm healing could avoid future risks of in-stent thrombosis and the need for lifelong antiplatelet therapy.ObjectiveTo assess the applicability and compatibility of a bioresorbable magnesium- alloy stent (brMAS) for assisted coiling.MethodsSaccular sidewall aneurysms were created in 84 male Wistar rats and treated with brMAS alone, brMAS + aspirin, or brMAS + coils + aspirin. Control groups included no treatment (natural course), solely aspirin treatment, or conventional cobalt–chromium stent + coils + aspirin treatment. After 1 and 4 weeks, aneurysm specimens were harvested and macroscopically, histologically, and molecularly examined for healing, parent artery perfusion status, and inflammatory reactions. Stent degradation was monitored for up to 6 months with micro-computed and optical coherence tomography.ResultsAneurysms treated with brMAS showed advanced healing, neointima formation, and subsequent stent degradation. Additional administration of aspirin sustained aneurysm healing while reducing stent-induced intraluminal and periadventitial inflammatory responses. No negative interaction was detected between platinum coils and brMAS. Progressive brMAS degradation was confirmed.ConclusionsbrMAS induced appropriate healing in this sidewall aneurysm model. The concept of using bioresorbable materials to promote complete aneurysm healing and subsequent stent degradation seems promising. These results should encourage further device refinements and clinical evaluation of this treatment strategy for cerebrovascular aneurysms.
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Marbacher S, Frösén J, Marjamaa J, Anisimov A, Honkanen P, von Gunten M, Abo-Ramadan U, Hernesniemi J, Niemelä M. Intraluminal Cell Transplantation Prevents Growth and Rupture in a Model of Rupture-Prone Saccular Aneurysms. Stroke 2014; 45:3684-90. [DOI: 10.1161/strokeaha.114.006600] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Serge Marbacher
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Juhana Frösén
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Johan Marjamaa
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Andrey Anisimov
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Petri Honkanen
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Michael von Gunten
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Usama Abo-Ramadan
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Juha Hernesniemi
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
| | - Mika Niemelä
- From the Department of Neurosurgery, Neurosurgery Research Group, Biomedicum Helsinki, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.F., J.M., P.H., J.H., M.N.); Wihuri Research Institute, Translational Cancer Biology Program, Biomedicum Helsinki (A.A.) and Department of Neurology, Institute of Biomedicine, Experimental MRI Laboratory (U.A.-R.), University of Helsinki, Helsinki, Finland; and Institute of Pathology Laenggasse, Bern, Switzerland (M.v.G.)
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Marbacher S, Neuschmelting V, Andereggen L, Widmer HR, von Gunten M, Takala J, Jakob SM, Fandino J. Early brain injury linearly correlates with reduction in cerebral perfusion pressure during the hyperacute phase of subarachnoid hemorrhage. Intensive Care Med Exp 2014; 2:30. [PMID: 26266927 PMCID: PMC4512974 DOI: 10.1186/s40635-014-0030-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023] Open
Abstract
Background It is unclear how complex pathophysiological mechanisms that result in early brain injury (EBI) after subarachnoid hemorrhage (SAH) are triggered. We investigate how peak intracranial pressure (ICP), amount of subarachnoid blood, and hyperacute depletion of cerebral perfusion pressure (CPP) correlate to the onset of EBI following experimental SAH. Methods An entire spectrum of various degrees of SAH severities measured as peak ICP was generated and controlled using the blood shunt SAH model in rabbits. Standard cardiovascular monitoring, ICP, CPP, and bilateral regional cerebral blood flow (rCBF) were continuously measured. Cells with DNA damage and neurodegeneration were detected using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Fluoro-jade B (FJB). Results rCBF was significantly correlated to reduction in CPP during the initial 15 min after SAH in a linear regression pattern (r2 = 0.68, p < 0.001). FJB- and TUNEL-labeled cells were linearly correlated to reduction in CPP during the first 3 min of hemorrhage in the hippocampal regions (FJB: r2 = 0.50, p < 0.01; TUNEL: r2 = 0.35, p < 0.05), as well as in the basal cortex (TUNEL: r2 = 0.58, p < 0.01). EBI occurred in animals with severe (relative CPP depletion >0.4) and moderate (relative CPP depletion >0.25 but <0.4) SAH. Neuronal cell death was equally detected in vulnerable and more resistant brain regions. Conclusions The degree of EBI in terms of neuronal cell degeneration in both the hippocampal regions and the basal cortex linearly correlates with reduced CPP during hyperacute SAH. Temporary CPP reduction, however, is not solely responsible for EBI but potentially triggers processes that eventually result in early brain damage. Electronic supplementary material The online version of this article (doi:10.1186/s40635-014-0030-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Serge Marbacher
- Cerebrovascular Research Laboratory of the Department of Intensive Care Medicine, University Hospital and University of Bern, 3010, Bern, Switzerland,
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Andereggen L, Neuschmelting V, von Gunten M, Widmer HR, Takala J, Jakob SM, Fandino J, Marbacher S. The rabbit blood-shunt model for the study of acute and late sequelae of subarachnoid hemorrhage: technical aspects. J Vis Exp 2014:e52132. [PMID: 25350004 DOI: 10.3791/52132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Early brain injury and delayed cerebral vasospasm both contribute to unfavorable outcomes after subarachnoid hemorrhage (SAH). Reproducible and controllable animal models that simulate both conditions are presently uncommon. Therefore, new models are needed in order to mimic human pathophysiological conditions resulting from SAH. This report describes the technical nuances of a rabbit blood-shunt SAH model that enables control of intracerebral pressure (ICP). An extracorporeal shunt is placed between the arterial system and the subarachnoid space, which enables examiner-independent SAH in a closed cranium. Step-by-step procedural instructions and necessary equipment are described, as well as technical considerations to produce the model with minimal mortality and morbidity. Important details required for successful surgical creation of this robust, simple and consistent ICP-controlled SAH rabbit model are described.
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Affiliation(s)
- Lukas Andereggen
- Laboratories for Neuroscience Research in Neurosurgery, Boston Children's Hospital; Harvard Medical School, Boston Children's Hospital; Department of Neurosurgery, University and Bern University Hospital (Inselspital)
| | - Volker Neuschmelting
- Department of Intensive Care Medicine, University and Bern University Hospital (Inselspital); Department of Neurosurgery, University Hospital Cologne
| | | | - Hans Rudolf Widmer
- Department of Neurosurgery, University and Bern University Hospital (Inselspital)
| | - Jukka Takala
- Department of Intensive Care Medicine, University and Bern University Hospital (Inselspital)
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University and Bern University Hospital (Inselspital)
| | - Javier Fandino
- Department of Intensive Care Medicine, University and Bern University Hospital (Inselspital); Department of Neurosurgery, Kantonsspital Aarau
| | - Serge Marbacher
- Department of Intensive Care Medicine, University and Bern University Hospital (Inselspital); Department of Neurosurgery, Kantonsspital Aarau;
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Marbacher S, Marjamaa J, Bradacova K, von Gunten M, Honkanen P, Abo-Ramadan U, Hernesniemi J, Niemelä M, Frösen J. Loss of Mural Cells Leads to Wall Degeneration, Aneurysm Growth, and Eventual Rupture in a Rat Aneurysm Model. Stroke 2014; 45:248-54. [DOI: 10.1161/strokeaha.113.002745] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Serge Marbacher
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Johan Marjamaa
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Katerina Bradacova
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Michael von Gunten
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Petri Honkanen
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Usama Abo-Ramadan
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Juha Hernesniemi
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Mika Niemelä
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
| | - Juhana Frösen
- From the Neurosurgery Research Group, Biomedicum Helsinki and Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (S.M., J.M., K.B., P.H., J.H., M.N., J.F.); Institute of Pathology Länggasse, Bern, Switzerland (M.v.G.); and Experimental MRI Laboratory, Department of Neurology, Helsinki University Central Hospital and Institute of Biomedicine, University of Helsinki, Helsinki, Finland (U.A.-R.)
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Adler S, Kolev M, Varisco PA, Tham M, von Gunten M, Tappeiner C, Villiger PM. Induction of severe systemic lupus erythematosus by TNF blockade and response to anti-IL-6 strategy. J Allergy Clin Immunol 2012; 131:1235-7, 1237.e1. [PMID: 23154083 DOI: 10.1016/j.jaci.2012.09.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 11/24/2022]
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Lehr HA, Moch H, Christen B, Safret A, Gugger M, Rössle M, von Gunten M, Lemoine R, Kurt AM, Caduff R, Walter A, Singer G, Luscieti P, Bannwart F, Genton CY. Board examination for anatomical pathology in Switzerland: two intense days to verify professional competence. Virchows Arch 2012; 461:87-92. [PMID: 22718394 DOI: 10.1007/s00428-012-1262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 10/27/2022]
Abstract
About 15 years ago, the Swiss Society of Pathology has developed and implemented a board examination in anatomical pathology. We describe herein the contents covered by this 2-day exam (autopsy pathology, cytology, histopathology, molecular pathology, and basic knowledge about mechanisms of disease) and its exact modalities, sketch a brief history of the exam, and finish with a concise discussion about the possible objectives and putative benefits weighed against the hardship that it imposes on the candidates.
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Affiliation(s)
- Hans-Anton Lehr
- Institute of Pathology, University of Lausanne, Lausanne, Switzerland.
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Seiler R, von Gunten M, Thalmann GN, Fleischmann A. Extracapsular extension but not the tumour burden of lymph node metastases is an independent adverse risk factor in lymph node-positive bladder cancer. Histopathology 2011; 58:571-8. [DOI: 10.1111/j.1365-2559.2011.03778.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vajtai I, Stibal A, von Gunten M, Kappeler A, Vassella E, Frank S. Glycogen-rich pleomorphic xanthoastrocytoma with clear-cell features: confirmatory report of a rare variant with implications for differential diagnosis. Pathol Res Pract 2011; 207:256-61. [PMID: 21282017 DOI: 10.1016/j.prp.2010.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
Central nervous system space-occupying lesions with clear-cell features encompass a nosologically heterogeneous array, ranging from reactive histiocytic proliferations to neuroepithelial or meningothelial neoplasms of various grades and to metastases. In the face of such differential diagnostic breadth, recognizing cytoplasmic lucency as part of the morphological spectrum of some low grade gliomas will directly have an impact on patient care. We describe a prevailing clear-cell change in an epileptogenic left temporal pleomorphic xanthoastrocytoma surgically resected from a 36-year-old man. Mostly subarachnoid and focally calcified, the tumor was composed of fascicles of moderately atypical spindle cells with optically lucent cytoplasm that tended to intermingle with a desmoplastic mesh of reticulin fibers. Immunohistochemically, coexpression of S100 protein, vimentin, GFAP, and CD34 was noted. Conversely, neither punctate staining for EMA nor positivity for CD68 was seen. Mitotic activity was absent, and the MIB1 labeling index was 2-3% on average. Diastase-sensitive PAS-positive granula indicated clear-cell change to proceed from glycogen storage. Electron microscopy showed tumor cell cytoplasm to be largely obliterated by non-lysosomal-bound pools of glycogen, while hardly any fat vacuole was encountered. Neither ependymal-derived organelles nor annular lamellae suggesting oligodendroglial differentiation were detected. The latter differential diagnosis was further invalidated by lack of codeletion of chromosomal regions 1p36 and 19q13 on molecular genetic testing. By significantly interfering with pattern recognition as an implicit approach in histopathology, clear-cell change in pleomorphic xanthoastrocytoma is likely to suspend its status as a "classic", and to prompt more deductive differential diagnostic strategies to exclude look-alikes, especially clear-cell ependymoma and oligodendroglioma.
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Affiliation(s)
- Istvan Vajtai
- Neuropathology Service, Institute of Pathology, University of Bern, Bern, Switzerland.
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Vajtai I, von Gunten M, Fung C, Brekenfeld C, Kappeler A, Reinert MM. Oncocytic ependymoma: A new morphological variant of high-grade ependymal neoplasm composed of mitochondrion-rich epithelioid cells. Pathol Res Pract 2011; 207:49-54. [DOI: 10.1016/j.prp.2010.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 05/07/2010] [Accepted: 05/19/2010] [Indexed: 01/24/2023]
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Abstract
Aims To evaluate the number of lymph nodes and the lymph node tumour burden in different anatomical pelvic regions to better asses the impact of variations in the extent of lymphadenectomy on reported LN parameters and pelvic tumour clearance. Methods 162 patients with lymph-node-positive urothelial carcinoma of the bladder were treated by cystectomy and extended pelvic lymphadenectomy. Various lymph node parameters were determined separately for the three pelvic regions (external iliac, obturator and internal iliac). Results Of 4080 evaluated lymph nodes (median 25 per patient, range 8–55) 39%, 35% and 26% (p<0.05) were found in the external iliac, obturator and internal iliac region, respectively. The distribution of the 625 lymph node metastases (median two per patient, range 1–35) was not significantly different between the regions (external iliac 33%, obturator 38%, internal iliac 29%). However, the median diameter of largest metastasis and total diameter of all metastases were smallest in the internal iliac region (external iliac 0.85 cm, 1.1 cm; obturator 0.8 cm, 1.0 cm; internal iliac 0.6 cm, 0.8 cm; p<0.03, p<0.05; for median diameter of largest metastasis and total diameter of all metastases, respectively). Metastases in only one region were found in 33% of patients (external iliac 13%, obturator 10%, internal iliac 10%); these three groups showed no significant difference in survival. No difference was detected in lymph node parameters between genders. Conclusions Lymph node counts and retrieval of metastases depends on the extent of pelvic lymphadenectomy. Dissection not including the internal iliac region misses 26% of all pelvic lymph nodes, 29% of metastases, and understages a substantial number of patients as pN0 (10%).
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Affiliation(s)
- Roland Seiler
- Department of Pathology, University of Bern, Switzerland
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Seiler R, von Gunten M, Fleischmann A, Thalmann GN. 1718 HIGH CD10 EXPRESSION IN THE PRIMARY TUMOR INDEPENDENTLY PREDICTS FAVORABLE SURVIVAL IN SURGICALLY TREATED PATIENTS WITH LYMPH NODE POSITIVE UROTHELIAL CANCER OF THE BLADDER. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Seiler R, von Gunten M, Fleischmann A, Studer UE, Thalmann GN. 1646 EXTRACAPSULAR EXTENSION OF LYMPH NODE METASTASES BUT NOT LYMPH NODE TUMOR BURDEN IS AN INDEPENDENT PREDICTIVE FACTOR OF SURVIVAL IN LYMPH NODE POSITIVE UROTHELIAL CANCER OF THE BLADDER. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lüer S, Berger S, Diepold M, Duppenthaler A, von Gunten M, Mühlethaler K, Wolf R, Aebi C. Treatment of intestinal and hepatic mucormycosis in an immunocompromized child. Pediatr Blood Cancer 2009; 52:872-4. [PMID: 19127570 DOI: 10.1002/pbc.21918] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
During ALL chemotherapy, a 4-year-old patient presented with febrile neutropenia and abdominal pain. Ultrasound examinations were repeatedly normal. Computerized tomography on day 7 demonstrated appendicitis and multiple hepatic foci identified as mucormycosis (Absidia corymbifera). Successful outcome was achieved by aggressive re-surgery, long-term antifungal therapy with serum level-monitored posaconazole, and recovery of neutrophil counts. Considering the interference of posaconazole with CYP3A4, vincristine was administered during 72 hr posaconazole windows. Pediatric intestinal mucormycosis, still associated with a >70% case-fatality rate, calls for early imaging and surgery to establish the diagnosis, reduce the fungal mass, and provide a rationale for using posaconazole.
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Affiliation(s)
- Sonja Lüer
- Division of Pediatric Hematology, Department of Pediatrics, University of Bern, Bern, Switzerland
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