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Li Y, Schappell LE, Polizu C, DiPersio J, Tsirka SE, Halterman MW, Nadkarni NA. Evolving Clinical-Translational Investigations of Cerebroprotection in Ischemic Stroke. J Clin Med 2023; 12:6715. [PMID: 37959180 PMCID: PMC10649331 DOI: 10.3390/jcm12216715] [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: 09/02/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Ischemic stroke is a highly morbid disease, with over 50% of large vessel stroke (middle cerebral artery or internal carotid artery terminus occlusion) patients suffering disability despite maximal acute reperfusion therapy with thrombolysis and thrombectomy. The discovery of the ischemic penumbra in the 1980s laid the foundation for a salvageable territory in ischemic stroke. Since then, the concept of neuroprotection has been a focus of post-stroke care to (1) minimize the conversion from penumbra to core irreversible infarct, (2) limit secondary damage from ischemia-reperfusion injury, inflammation, and excitotoxicity and (3) to encourage tissue repair. However, despite multiple studies, the preclinical-clinical research enterprise has not yet created an agent that mitigates post-stroke outcomes beyond thrombolysis and mechanical clot retrieval. These translational gaps have not deterred the scientific community as agents are under continuous investigation. The NIH has recently promoted the concept of cerebroprotection to consider the whole brain post-stroke rather than just the neurons. This review will briefly outline the translational science of past, current, and emerging breakthroughs in cerebroprotection and use of these foundational ideas to develop a novel paradigm for optimizing stroke outcomes.
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Affiliation(s)
- Yinghui Li
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA; (Y.L.); (L.E.S.); (C.P.); (J.D.); (M.W.H.)
| | - Laurel E. Schappell
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA; (Y.L.); (L.E.S.); (C.P.); (J.D.); (M.W.H.)
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA;
| | - Claire Polizu
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA; (Y.L.); (L.E.S.); (C.P.); (J.D.); (M.W.H.)
| | - James DiPersio
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA; (Y.L.); (L.E.S.); (C.P.); (J.D.); (M.W.H.)
| | - Stella E. Tsirka
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA;
| | - Marc W. Halterman
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA; (Y.L.); (L.E.S.); (C.P.); (J.D.); (M.W.H.)
| | - Neil A. Nadkarni
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8651, USA; (Y.L.); (L.E.S.); (C.P.); (J.D.); (M.W.H.)
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Nadkarni NA, Arias E, Fang R, Haynes ME, Zhang HF, Muller WA, Batra A, Sullivan DP. Platelet Endothelial Cell Adhesion Molecule (PECAM/CD31) Blockade Modulates Neutrophil Recruitment Patterns and Reduces Infarct Size in Experimental Ischemic Stroke. Am J Pathol 2022; 192:1619-1632. [PMID: 35952762 PMCID: PMC9667712 DOI: 10.1016/j.ajpath.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
The infiltration of polymorphonuclear leukocytes (PMNs) in ischemia-reperfusion injury (I/RI) has been implicated as a critical component of inflammatory damage following ischemic stroke. However, successful blockade of PMN transendothelial migration (TEM) in preclinical studies has not translated to meaningful clinical outcomes. To investigate this further, leukocyte infiltration patterns were quantified, and these patterns were modulated by blocking platelet endothelial cell adhesion molecule-1 (PECAM), a key regulator of TEM. LysM-eGFP mice and microscopy were used to visualize all myeloid leukocyte recruitment following ischemia/reperfusion. Visual examination showed heterogeneous leukocyte distribution across the infarct at both 24 and 72 hours after I/RI. A semiautomated process was designed to precisely map PMN position across brain sections. Treatment with PECAM function-blocking antibodies did not significantly affect total leukocyte recruitment but did alter their distribution, with more observed at the cortex at both early and later time points (24 hours: 89% PECAM blocked vs. 72% control; 72 hours: 69% PECAM blocked vs. 51% control). This correlated with a decrease in infarct volume. These findings suggest that TEM, in the setting of I/RI in the cerebrovasculature, occurs primarily at the cortical surface. The reduction of stroke size with PECAM blockade suggests that infiltrating PMNs may exacerbate I/RI and indicate the potential therapeutic benefit of regulating the timing and pattern of leukocyte infiltration after stroke.
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Affiliation(s)
- Neil A Nadkarni
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - Erika Arias
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Raymond Fang
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Maureen E Haynes
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Hao F Zhang
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - William A Muller
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Ayush Batra
- Department of Neurology, Northwestern University, Chicago, Illinois; Department of Pathology, Northwestern University, Chicago, Illinois
| | - David P Sullivan
- Department of Pathology, Northwestern University, Chicago, Illinois.
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Nadkarni NA, Batra A. Management of Acute Ischemic Stroke With Interventional Clot Retrieval. Crit Care 2022. [DOI: 10.1093/med/9780190885939.003.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The care of patients with acute ischemic stroke has rapidly changed in domains of diagnostic expediency and options for management. Coordinated multidisciplinary specialty care, improving technology, and favorable outcomes in clinical trials have increased the number of patients eligible for intervention by both systemic thrombolytic therapy and directed mechanical clot retrieval. The extended time window for reperfusion of cerebrovascular flow has subsequently increased salvage of the ischemic penumbra, decreasing overall infarct size and improving patient functional outcomes. The advances in mechanical thrombectomy, specifically in regards to the extended time windows for treatment eligibility, now offer hope to patients who were previously destined to severe morbidity and mortality. The authors of this chapter review indications for acute stroke therapy, methods for streamlining immediate care, key diagnostic imaging findings, results of the major thrombectomy trials, and complications for the post-interventional patient.
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Nadkarni NA, Fang R, Muller WA, Sullivan D, Zhang HF. Abstract WP258: Post-stroke Microvascular No-reflow Demonstrates Spatiotemporal Heterogeneity Using Visible-Light Optical Coherence Tomography. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The spatiotemporal pattern of microvascular reperfusion in vivo after large vessel recanalization is poorly understood. Combining chronic cranial window with embedded microprism (CCW-MP) and visible-light optical coherence tomography angiography (Vis-OCTA) enables the study of mouse cortical cerebrovasculature up to 60 days post-stroke. Vis-OCTA/CCW-MP can identify the presence or absence of microvascular flow, without labelling, up to 1 mm in cortical depth of the mouse brain at 1.3 micron resolution. We sought to build on these findings to understand the pattern of microvascular no-reflow in a mouse model of stroke that simulates large vessel occlusion and reperfusion.
Hypothesis:
Different regions of the cortex have striking variation in flow characteristics after macrovascular reperfusion.
Methods:
All mice studied were 3-4 mo old, C57/Bl6 background, and subject to IMPROVE guideline. Control mice (n=3) were studied to confirm absence of cortical or vascular changes induced by CCW-MP surgery. Test mice (n =6) underwent CCW-MP as previously published. After 2 weeks to allow for healing post-surgery, mice were subject to transient middle cerebral artery occlusion (tMCAO) to model large vessel occlusion and reperfusion. Vis-OCTA measured cortical flow at baseline, 24 hours post-stroke, and 72 hours post-stroke. Cortical mouse vascular regions were divided into layers 1-3: layer 4 : layer 5-6 from top to bottom.
Results:
Control mice showed no neuronal death, astrogliosis, microgliosis, or neutrophil recruitment induced by CCW-MP implantation. There was no significant difference between vascular density for prism-adjacent cortex and prism-remote cortex. We also determined that the CCW-MP images cortical vascular territory supplied by the middle cerebral artery. For the test mice, all six mice survived combined surgery. Vis-OCTA showed four of six mice had reduction of microvascular flow > 20% from baseline by 72h post-stroke at layer 5-6.
Conclusions:
Microvascular reperfusion post large vessel recanalization can be incomplete up to 72 hours post-stroke, especially at deeper cortical levels. Further studies should define associated changes in inflammatory cells as well as oxygenation of vessels.
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Batra A, Nadkarni NA, Muller WA, Sullivan DP. Transient ischemic stroke induces substantial leukocyte recruitment to both the ischemic and non‐ischemic cerebrovasculature as visualized through live animal imaging. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.05376] [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: 11/11/2022]
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Batra A, Nadkarni NA, Muller WA, Sullivan DP. Abstract WMP80: Live Animal Imaging Reveals Delayed But Sustained Neutrophil Recruitment to Both Ischemic and Non-Ischemic Cortical Cerebrovasculature in a Mouse Transient Stroke Model. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp80] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
Background:
Treatment for acute ischemic stroke (AIS) relies on early restoration of blood flow; however, injury persists despite reperfusion. The innate immune response plays a pivotal role in reperfusion injury, but the mechanisms and timing of neutrophil recruitment to the cerebrovasculature (CBV) during AIS remain unclear. We sought to characterize the neutrophil response in the CBV following ischemia/reperfusion using a transient middle cerebral artery occlusion (tMCAO) AIS model.
Methods:
Fluorescent reporter mice underwent 90-minute tMCAO confirmed with LSCI or surgery without occlusion (sham). Real-time confocal intravital microscopy of the CBV was performed at 24 and 72 hrs post-reperfusion through cranial windows in ischemic and non-ischemic hemispheres. Neutrophil recruitment (adhesion, rolling) and extravasation were quantified in vivo over both hemispheres. Neutrophil extravasation was further quantified using whole mount sections. Infarct volume was measured by 2,3,5-triphenyltetrazolium chloride staining.
Results:
An increase in neutrophil rolling, adhesion and extravasation was observed within the ischemic hemisphere compared to sham (p < 0.01) at 24 and markedly 72 hrs. Non-ischemic hemispheres showed increased neutrophil rolling and adhesion, but not extravasation, compared to sham surgery (p < 0.05). Whole mount sections demonstrated increased cortical and subcortical neutrophil extravasation in the ischemic hemisphere only (p < 0.01).
Conclusions:
Early neutrophil recruitment to the ischemic hemisphere following tMCAO was present at both the CBV and within the infarcted parenchyma at 72 hours. Acute neutrophil recruitment at the CBV in the non-ischemic hemisphere, but not the cortex, suggests that AIS triggers a global inflammatory response within the CBV. Targeted neutrophil-specific therapies during reperfusion may reduce global inflammation at the CBV, and potentially mitigate secondary neuronal injury.
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Affiliation(s)
- Ayush Batra
- Neurology, Pathology, Northwestern Univ, Chicago, IL
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Nadkarni NA, Batra A, Muller WA, Sullivan DP. Abstract TP266: Ischemic Stroke Induces Striking Heterogeneity in the Inflammatory Leukocyte Infiltrate Across the Core and Penumbra. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Current therapies for ischemic stroke focus on reperfusion but do not address the acute inflammatory response. Previous clinical trials aimed at modulating the inflammatory milieu by disrupting leukocyte infiltration failed to show clinical efficacy. One possible explanation for this unexpected shortcoming is an incomplete understanding of the precise spatio-temporal underpinnings of leukocyte extravasation and infiltration.
Methods:
Here we describe the evolution of the inflammatory response in a mouse transient middle cerebral artery occlusion (tMCAO) stroke model at 0, 1, 2 and 3 days post reperfusion. We used wide field and confocal immunofluorescence microscopy to examine the exact nature and location of the invading myelomonocytic populations, with close examination of the leukocyte position with regard to the brain vasculature and the perivascular space.
Results:
Our findings suggest that the vast majority of infiltrating myelomonocytic cells escape the perivascular compartment and enter the parenchyma. Interestingly, leukocyte extravasation and accumulation in the subcortex occurred over several days. Dramatic heterogeneity in the inflammatory infiltrate was observed across the infarcted tissue, but also in the surrounding penumbra and adjacent cortical surface. In addition, triphenyl tetrazolium chloride staining, a common indicator for infarcted tissue, did not correlate with the amount or location of leukocyte infiltration.
Conclusion:
Taken together our findings demonstrate that the infiltration of leukocytes dynamically evolves over several days following reperfusion. Furthermore, leukocytes infiltrate in a heterogeneous pattern that does not correlate well with traditional markers of cellular dysfunction. A better understating of the precise spatio-temporal infiltration of inflammatory cells could help inform the next generation of therapeutic interventions.
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Affiliation(s)
- Neil A Nadkarni
- Neurology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - Ayush Batra
- Neurology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - William A Muller
- Pathology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
| | - David P Sullivan
- Pathology, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL
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Nadkarni NA, Maas MB, Batra A, Kim M, Manno EM, Sorond FA, Prabhakaran S, Naidech AM, Liotta EM. Elevated Cerebrospinal Fluid Protein Is Associated with Unfavorable Functional Outcome in Spontaneous Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:104605. [PMID: 31932209 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Subarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. We sought to determine if CSF protein level is associated with functional outcome after SAH. METHODS We prospectively collected single-center demographic and clinical data for consecutive patients admitted with spontaneous SAH. Inclusion required an external ventricular drain and daily CSF protein and cellular counts starting within 48 hours of symptom onset and extending through 7 days after onset. Seven-day average CSF protein was determined from daily measured values after correcting for contemporaneous CSF red blood cell (RBC) count. Three-month functional outcome was assessed by telephone interview with good outcome defined as modified Rankin score 0-3. Variables univariately associated with outcome at P less than .25 and measures of hemorrhage volume were included for binary logistic regression model development. RESULTS The study included 130 patients (88% aneurysmal SAH, 69% female, 54.8 ± 14.8 years, Glasgow Coma Scale [GCS] 14 [7-15]). Three-month outcome assessment was complete in 112 (86%) patients with good functional outcome in 74 (66%). CSF protein was lower in good outcome (35.3 [20.4-49.7] versus 80.5 [40.5-115.5] mg/dL; P < .001). CSF protein was not associated with cerebral vasospasm, but delayed radiographic infarction on 3 to 12-month neuroimaging was associated with higher CSF protein (46.3 [32.0-75.0] versus 30.2 [20.4-47.8] mg/dL; P = .023). Good 3-month outcome was independently associated with lower CSF protein (odds ratios [OR] .39 [.23-.70] for 75th versus 25th percentile of protein; P = .001) and higher admission GCS (OR 1.23 [1.10-1.37] for good outcome per GCS point increase; P < .001). Parenchymal hematoma predicted worse outcome (OR 6.31 [1.58-25.25]; P = .009). Results were similar after excluding nonaneurysmal SAH and after including CSF RBC count, CT score, and intraventricular hemorrhage volume in models. CONCLUSIONS Elevated average CSF protein is associated with poor outcome after spontaneous SAH. Further research should investigate if elevated CSF protein identifies patients in whom mechanisms such as BBB disruption contribute to poor outcome.
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Affiliation(s)
- Neil A Nadkarni
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Matthew B Maas
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Ayush Batra
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Minjee Kim
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Edward M Manno
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Shyam Prabhakaran
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Andrew M Naidech
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Eric M Liotta
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.
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Beckmann L, Zhang X, Nadkarni NA, Cai Z, Batra A, Sullivan DP, Muller WA, Sun C, Kuranov R, Zhang HF. Longitudinal deep-brain imaging in mouse using visible-light optical coherence tomography through chronic microprism cranial window. Biomed Opt Express 2019; 10:5235-5250. [PMID: 31646044 PMCID: PMC6788609 DOI: 10.1364/boe.10.005235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 05/02/2023]
Abstract
We longitudinally imaged both the superficial and deep cortical microvascular networks in brains of healthy mice and in a mouse model of stroke in vivo using visible-light optical coherence tomography (vis-OCT). We surgically implanted a microprism in mouse brains sealed by a chronic cranial window. The microprism enabled vis-OCT to image the entire depth of the mouse cortex. Following microprism implantation, we imaged the mice for 28 days and found that that it took around 15 days for both the superficial and deep cortical microvessels to recover from the implantation surgery. After the brains recovered, we introduced ischemic strokes by transient middle cerebral artery occlusion (tMCAO). We monitored the strokes for up to 60 days and observed different microvascular responses to tMCAO at different cortical depths in both the acute and chronic phases of the stroke. This work demonstrates that the combined microprism and cranial window is well-suited for longitudinal investigation of cortical microvascular disorders using vis-OCT.
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Affiliation(s)
- Lisa Beckmann
- Department of Biomedical Engineering, Northwestern University, Evanston IL 60208, USA
- These authors contributed equally to this work
| | - Xian Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston IL 60208, USA
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, Hubei, China
- These authors contributed equally to this work
| | - Neil A. Nadkarni
- Department of Neurology, Northwestern University, Chicago IL 60611, USA
| | - Zhen Cai
- Department of Biomedical Engineering, Northwestern University, Evanston IL 60208, USA
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, Hubei, China
| | - Ayush Batra
- Department of Neurology, Northwestern University, Chicago IL 60611, USA
| | - David P. Sullivan
- Department of Pathology, Northwestern University, Chicago IL 60611, USA
| | - William A. Muller
- Department of Pathology, Northwestern University, Chicago IL 60611, USA
| | - Cheng Sun
- Department of Mechanical Engineering, Northwestern University, Evanston IL 60208, USA
| | - Roman Kuranov
- Department of Biomedical Engineering, Northwestern University, Evanston IL 60208, USA
- Opticent Health, Evanston IL, Evanston IL 60201, USA
| | - Hao F. Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston IL 60208, USA
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Adrissi J, Nadkarni NA, Gausche E, Bega D. Electroconvulsive Therapy (ECT) for Refractory Psychiatric Symptoms in Huntington's Disease: A Case Series and Review of the Literature. J Huntingtons Dis 2019; 8:291-300. [PMID: 31322579 DOI: 10.3233/jhd-190361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/15/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a progressive neurodegenerative disease characterized by involuntary movements and neuropsychiatric decline. With suicide rates five times higher in patients with HD compared to the general population, there is a need for further research into the management of affective symptoms in these patients. Electroconvulsive therapy (ECT) has been long used as a treatment for severe or medication-refractory mood disorders and catatonia. There are some case studies demonstrating ECT's positive effect on depression and agitation in HD, but the data is limited. OBJECTIVE In this single site case series, we review ECT use for four HD patients with medication-refractory depression and/or psychosis to better assess the utility of ECT in this population. We also compile and review the existing literature on the topic. METHODS A single-center retrospective case series was conducted reviewing the indications, outcomes, and regimen of ECT treatments. Literature review was conducted via PubMed. RESULTS Four patients received ECT treatment during an inpatient hospitalization with three continuing maintenance therapy as an outpatient. All four had improvements in depression, agitation, and suicidal ideation leading to successful hospital discharge. One of the four patients also demonstrated subjective improvement in cognitive and motor symptoms after ECT initiation. Nineteen reported cases were identified through the literature review and are summarized. CONCLUSIONS This case series adds to the existing literature demonstrating the successful use of ECT for psychiatric symptoms in HD. Larger scale studies are warranted to further investigate the specific role and protocol for the use of ECT in the management of refractory depression and psychosis in this population.
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Affiliation(s)
- Jennifer Adrissi
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Neil A Nadkarni
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Eric Gausche
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Danny Bega
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Deason RG, Nadkarni NA, Tat MJ, Flannery S, Frustace B, Ally BA, Budson AE. The use of metacognitive strategies to decrease false memories in source monitoring in patients with mild cognitive impairment. Cortex 2017; 91:287-296. [PMID: 28245935 DOI: 10.1016/j.cortex.2017.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/03/2016] [Accepted: 01/26/2017] [Indexed: 11/17/2022]
Abstract
Patients with amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD) often demonstrate high rates of false memories, leading to stressful and frustrating situations for both patients and caregivers in everyday life. Sometimes these false memories are due to failures in monitoring the source of the information. In the current study, we examined interventions aimed to enhance the use of the metacognitive "recall-to-reject" memory strategy. Such interventions could improve source memory and decrease false memory in patients with MCI. Because the picture superiority effect (better memory for pictures compared to words) has been shown to be present in both patients with MCI and healthy older controls, we investigated whether pictures could help patients with MCI use a recall-to-reject strategy in a simulation of real-world source memory task. In this experiment, patients with MCI and healthy older adults were asked to simulate preparing for and then taking a trip to the market. Subjects first studied 30 pictures of items in their "cupboard," followed by a list of 30 words of items on their "shopping list." At test, participants saw 90 pictures (30 cupboard, 30 list, 30 new) organized as they would be if walking down the market aisles, and are provided with either standard or metacognitive instructions. With standard instructions, they were asked if they needed to buy the item. With the metacognitive instructions, they were asked a series of questions to help guide them through a recall-to-reject strategy to highlight the different sources of memories. Results showed that the metacognitive instructions did significantly reduce the false memory rates for patients with MCI. Further studies need to investigate how to best implement these practical strategies into the everyday lives of patients.
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Affiliation(s)
- Rebecca G Deason
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Neil A Nadkarni
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston MA, USA
| | - Michelle J Tat
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston MA, USA
| | - Sean Flannery
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston MA, USA
| | - Bruno Frustace
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston MA, USA
| | - Brandon A Ally
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, MA, USA; Boston University Alzheimer's Disease Center, Boston University School of Medicine, Boston MA, USA
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Nadkarni NA, Rajakumar A, Mokhashi N, Burke SD, Rana S, Salahuddin S, Dang Q, Thadhani R, Krishnan R, Stossel TP, Karumanchi SA. Gelsolin is an endogenous inhibitor of syncytiotrophoblast extracellular vesicle shedding in pregnancy. Pregnancy Hypertens 2016; 6:333-339. [PMID: 27939478 DOI: 10.1016/j.preghy.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preeclampsia, a pregnancy-specific inflammatory disorder, is characterized by high levels of anti-angiogenic protein, soluble fms-like tyrosine kinase 1 (sFlt1), in the maternal circulation. sFlt1 producing molecular machinery is present in syncytiotrophoblast extracellular vesicles that are released by the placenta into maternal plasma during normal pregnancy, a process greatly accelerated in preeclampsia. We hypothesized that syncytiotrophoblast extracellular vesicles exposes cytoplasmic actin to plasma resulting in depletion of plasma gelsolin (pGSN), an abundant plasma protein that scavenges circulating actin and other pro-inflammatory mediators. OBJECTIVE To test whether pGSN levels would be lower in preeclampsia and to assess whether recombinant human plasma gelsolin (rhpGSN) may promote placental health by decreasing shedding of syncytiotrophoblast extracellular vesicles. METHODS We tested pGSN levels in third trimester plasma samples from women with preeclampsia and non-hypertensive pregnancies. We then assessed whether rhpGSN may act as a negative regulator of syncytial shedding in placental explant culture and dynamic mechanical stretch studies. RESULTS pGSN levels fall in late pregnancy and decline further in preeclampsia patients. Recombinant human pGSN (rhpGSN) at 100μg/ml limits spontaneous syncytiotrophoblast vesicle release and sFlt1 protein dissemination by normal placental explants. Higher rhpGSN doses (500μg/ml) also limit syncytiotrophoblast vesicle and sFlt1 dissemination from preeclamptic placental explants. rhpGSN also mitigates syncytiotrophoblast vesicle during dynamic mechanical stretch. CONCLUSIONS 1) pGSN, an anti-inflammatory factor of maternal origin is reduced in preeclampsia and may contribute to disease progression and 2) exogenous rhpGSN supplementation can limit the dissemination of toxic syncytiotrophoblast vesicle that characterizes the disease state.
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Affiliation(s)
- Neil A Nadkarni
- Department of Neurology, McGaw Northwestern Memorial Hospital, Chicago, IL, United States; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Augustine Rajakumar
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA, United States
| | - Nikita Mokhashi
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Suzanne D Burke
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Sarosh Rana
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology University of Chicago, Chicago, IL, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Medical Center, Harvard Medical School, Boston, MA, United States
| | - Saira Salahuddin
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Medical Center, Harvard Medical School, Boston, MA, United States
| | - Quynh Dang
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Emergency Medicine, Beth Israel Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ravi Thadhani
- Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ramaswamy Krishnan
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Emergency Medicine, Beth Israel Medical Center, Harvard Medical School, Boston, MA, United States
| | - Thomas P Stossel
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - S Ananth Karumanchi
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Medical Center, Harvard Medical School, Boston, MA, United States.
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Shenoy VV, Joshi SR, Aklujkar AP, Kotwal VS, Nadkarni NA, Ramraje NN. Pulmonary hydatid cyst in HIV-1 disease. J Assoc Physicians India 2005; 53:1070-2. [PMID: 16572967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A 36-year-old male patient, a known case of retroviral disease, presented with clinical features suggestive of pneumonia and was found to have bilateral lower zone lung consolidation which on resolution showed a cystic change on the chest radiograph. A subsequent CT scan revealed the true nature of these cysts to be ruptured pulmonary hydatid cysts showing a 'water lily sign'. The rare association of pulmonary hydatid cyst and HIV from India is described.
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Affiliation(s)
- V V Shenoy
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
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