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Cai P, Luo H, Xu H, Zhu X, Xu W, Dai Y, Xiao J, Cao Y, Zhao Y, Zhao BQ, Fan W. Recombinant ADAMTS 13 Attenuates Brain Injury After Intracerebral Hemorrhage. Stroke 2015; 46:2647-53. [PMID: 26251246 DOI: 10.1161/strokeaha.115.009526] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/07/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Inflammatory responses and blood-brain barrier (BBB) dysfunction play important roles in brain injury after intracerebral hemorrhage (ICH). The metalloprotease ADAMTS 13 (a disintegrin and metalloprotease with thrombospondin type I motif, member 13) was shown to limit inflammatory responses through its proteolytic effects on von Willebrand factor. In the present study, we addressed the role of ADAMTS 13 after experimental ICH. METHODS ICH was induced in mice by intracerebral infusion of autologous blood. The peri-hematomal inflammatory responses, levels of matrix metalloproteinase-9 and intercellular adhesion molecule-1, pericyte coverage on brain capillaries, and BBB permeability were quantified at 24 hours. Functional outcomes, cerebral edema, and hemorrhagic lesion volume were quantified at day 3. RESULTS Treatment with recombinant ADAMTS 13 (rADAMTS 13) reduced the levels of chemokines and cytokines, myeloperoxidase activity, and microglia activation and neutrophil recruitment after ICH. rADAMTS 13 also decreased interleukin-6 expression in brain endothelial cells stimulated by lipopolysaccharide, whereas recombinant von Willebrand factor reversed this effect. The anti-inflammatory effect of rADAMTS 13 was accompanied by reduced expression of intercellular adhesion molecule-1 and less activation of matrix metalloproteinase, enhanced pericyte coverage of brain microvessels, and attenuated BBB disruption. Furthermore, neutrophil depletion protected against BBB damage, and rADAMTS 13 treatment had no further beneficial effect. Finally, treatment of mice with rADAMTS 13 reduced cerebral edema and hemorrhagic lesion volume and improved neurological functions. CONCLUSIONS Our findings reveal the importance of rADAMTS 13 in regulating pathological inflammation and BBB function and suggest that rADAMTS 13 may provide a new therapeutic strategy for ICH.
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Affiliation(s)
- Ping Cai
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Haiyu Luo
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Haochen Xu
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Ximin Zhu
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Wenfang Xu
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Yiqin Dai
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Jin Xiao
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Yongliang Cao
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Yuwu Zhao
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.)
| | - Bing-Qiao Zhao
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.).
| | - Wenying Fan
- From the State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Collaborative Innovation Center for Brain Science and School of Basic Medical Sciences, Fudan University, Shanghai, China (P.C., H.L., H.X., X.Z., W.X., Y.D., J.X., Y.C., B.-Q.Z.,W.F.); Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fujian, China (P.C.); and Neurologic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (Y.Z.).
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Goel A, Elias JE, Eapen CE, Ramakrishna B, Elias E. Idiopathic Non-Cirrhotic Intrahepatic Portal Hypertension (NCIPH)-Newer Insights into Pathogenesis and Emerging Newer Treatment Options. J Clin Exp Hepatol 2014; 4:247-56. [PMID: 25755567 PMCID: PMC4284211 DOI: 10.1016/j.jceh.2014.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/05/2014] [Indexed: 12/12/2022] Open
Abstract
Chronic microangiopathy of portal venules results in idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH). Recent data suggest a role for vasoactive factors of portal venous origin in the pathogenesis of this 'pure' vasculopathy of the liver. Enteropathies (often silent), are an important 'driver' of this disease. NCIPH is under-recognized and often mis-labeled as cryptogenic cirrhosis. Liver biopsy is needed to prove the diagnosis of NCIPH. In these patients, with advancing disease and increased porto-systemic shunting, the portal venous vasoactive factors bypass the liver filter and contribute to the development of pulmonary vascular endothelial disorders-porto-pulmonary hypertension and hepato-pulmonary syndrome as well as mesangiocapillary glomerulonephritis. Prognosis in NCIPH patients is determined by presence, recognition and management of associated disorders. With better understanding of the pathogenesis of NCIPH, newer treatment options are being explored. Imbalance in ADAMTS 13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13): vWF (von-Willebrand factor) ratio is documented in NCIPH patients and may have a pathogenic role. Therapeutic interventions to correct this imbalance may prove to be important in the management of NCIPH.
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Key Words
- ADAMTS 13
- CVID, common variable immunodeficiency
- HPS, hepato-pulmonary syndrome
- HVPG, hepatic venous pressure gradient
- IBD, inflammatory bowel disease
- NCIPH, non-cirrhotic intrahepatic portal hypertension
- NRH, nodular regenerative hyperplasia
- OPV, obliterative portal venopathy
- PPH, porto-pulmonary hypertension
- PVT, portal vein thrombosis
- SOS, sinusoidal obstruction syndrome
- endothelial dysfunction
- primary haemostasis
- tTG, Tissue transglutaminase
- von-Willebrand factor (vWF)
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Affiliation(s)
- Ashish Goel
- Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - Elwyn Elias
- Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India,Liver Unit, University Hospital Birmingham, Birmingham, UK,Address for correspondence: Elwyn Elias, Emeritus Professor, Liver Unit, University Hospital Birmingham, Birmingham, UK.
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