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Bowen-Forbes C, Armstrong E, Moses A, Fahlman R, Koosha H, Yager JY. Broccoli, Kale, and Radish Sprouts: Key Phytochemical Constituents and DPPH Free Radical Scavenging Activity. Molecules 2023; 28:molecules28114266. [PMID: 37298743 DOI: 10.3390/molecules28114266] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
Our research group previously found that broccoli sprouts possess neuroprotective effects during pregnancy. The active compound has been identified as sulforaphane (SFA), obtained from glucosinolate and glucoraphanin, which are also present in other crucifers, including kale. Sulforaphene (SFE), obtained from glucoraphenin in radish, also has numerous biological benefits, some of which supersede those of sulforaphane. It is likely that other components, such as phenolics, contribute to the biological activity of cruciferous vegetables. Notwithstanding their beneficial phytochemicals, crucifers are known to contain erucic acid, an antinutritional fatty acid. The aim of this research was to phytochemically examine broccoli, kale, and radish sprouts to determine good sources of SFA and SFE to inform future studies of the neuroprotective activity of cruciferous sprouts on the fetal brain, as well as product development. Three broccoli: Johnny's Sprouting Broccoli (JSB), Gypsy F1 (GYP), and Mumm's Sprouting Broccoli (MUM), one kale: Johnny's Toscano Kale (JTK), and three radish cultivars: Black Spanish Round (BSR), Miyashige (MIY), and Nero Tunda (NT), were analyzed. We first quantified the glucosinolate, isothiocyanate, phenolics, and DPPH free radical scavenging activity (AOC) of one-day-old dark- and light-grown sprouts by HPLC. Radish cultivars generally had the highest glucosinolate and isothiocyanate contents, and kale had higher glucoraphanin and significantly higher sulforaphane content than the broccoli cultivars. Lighting conditions did not significantly affect the phytochemistry of the one-day-old sprouts. Based on phytochemistry and economic factors, JSB, JTK, and BSR were chosen for further sprouting for three, five, and seven days and subsequently analyzed. The three-day-old JTK and radish cultivars were identified to be the best sources of SFA and SFE, respectively, both yielding the highest levels of the respective compound while retaining high levels of phenolics and AOC and markedly lower erucic acid levels compared to one-day-old sprouts.
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Affiliation(s)
| | - Edward Armstrong
- Department of Pediatrics, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Audric Moses
- Lipidomics Core Facility, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Richard Fahlman
- Department of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Helia Koosha
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jerome Y Yager
- Department of Pediatrics, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada
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Narayanamurthy R, Armstrong EA, Yang JLJ, Yager JY, Unsworth LD. Administration of selective brain hypothermia using a simple cooling device in neonatal rats. J Neurosci Methods 2023; 390:109838. [PMID: 36933705 DOI: 10.1016/j.jneumeth.2023.109838] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The interruption of oxygen and blood supply to the newborn brain around the time of birth is a risk factor for hypoxic-ischemic encephalopathy and may lead to infant mortality or lifelong neurological impairments. Currently, therapeutic hypothermia, the cooling of the infant's head or entire body, is the only treatment to curb the extent of brain damage. NEW METHOD In this study, we designed a focal brain cooling device that circulates cooled water at a steady state temperature of 19 ± 1 °C through a coil of tubing fitted onto the neonatal rat's head. We tested its ability to selectively decrease brain temperature and offer neuroprotection in a neonatal rat model of hypoxic-ischemic brain injury. RESULTS Our method cooled the brain to 30-33 °C in conscious pups, while keeping the core body temperature approximately 3.2 °C warmer. Furthermore, the application of the cooling device to the neonatal rat model demonstrated a reduction in brain volume loss compared to pups maintained at normothermia and achieved a level of brain tissue protection the same as that of whole-body cooling. COMPARISON WITH EXISTING METHODS Prevailing methods of selective brain hypothermia are designed for adult animal models rather than for immature animals such as the rat as a conventional model of developmental brain pathology. Contrary to existing methods, our method of cooling does not require surgical manipulation or anaesthesia. CONCLUSION Our simple, economical, and effective method of selective brain cooling is a useful tool for rodent studies in neonatal brain injury and adaptive therapeutic interventions.
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Affiliation(s)
- Rukhmani Narayanamurthy
- Department of Pediatrics, Division of Pediatric Neurosciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Edward A Armstrong
- Department of Pediatrics, Division of Pediatric Neurosciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Jung-Lynn Jonathan Yang
- Department of Chemical and Materials Engineering, University of Alberta, 11487 89 Avenue, Edmonton, Alberta T6G 2M7, Canada
| | - Jerome Y Yager
- Department of Pediatrics, Division of Pediatric Neurosciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, University of Alberta, 11487 89 Avenue, Edmonton, Alberta T6G 2M7, Canada.
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Noble RMN, Jahandideh F, Armstrong EA, Bourque SL, Yager JY. Broccoli Sprouts Promote Sex-Dependent Cardiometabolic Health and Longevity in Long-Evans Rats. Int J Environ Res Public Health 2022; 19:13468. [PMID: 36294045 PMCID: PMC9603818 DOI: 10.3390/ijerph192013468] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Antioxidants and anti-inflammatory compounds are potential candidates to prevent age-related chronic diseases. Broccoli sprouts (BrSp) are a rich source of sulforaphane-a bioactive metabolite known for its antioxidant and anti-inflammatory properties. We tested the effect of chronic BrSp feeding on age-related decline in cardiometabolic health and lifespan in rats. Male and female Long-Evans rats were fed a control diet with or without dried BrSp (300 mg/kg body weight, 3 times per week) from 4 months of age until death. Body weight, body composition, blood pressure, heart function, and glucose and insulin tolerance were measured at 10, 16, 20, and 22 months of age. Behavioral traits were also examined at 18 months of age. BrSp feeding prolonged life span in females, whereas in males the positive effects on longevity were more pronounced in a subgroup of males (last 25% of survivors). Despite having modest effects on behavior, BrSp profoundly affected cardiometabolic parameters in a sex-dependent manner. BrSp-fed females had a lower body weight and visceral adiposity while BrSp-fed males exhibited improved glucose tolerance and reduced blood pressure when compared to their control counterparts. These findings highlight the sex-dependent benefits of BrSp on improving longevity and delaying cardiometabolic decline associated with aging in rats.
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Affiliation(s)
- Ronan M. N. Noble
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Forough Jahandideh
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Edward A. Armstrong
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Stephane L. Bourque
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Jerome Y. Yager
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Li E, Smithson L, Khan M, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Effects of Perinatal Stroke on Executive Functioning and Mathematics Performance in Children. J Child Neurol 2022; 37:133-140. [PMID: 34985353 PMCID: PMC8801623 DOI: 10.1177/08830738211063683] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this study was to examine executive functioning, math performance, and visuospatial processing skills of children with perinatal stroke, which have not been well explored in this population. Participants included 18 children with perinatal stroke (aged 6-16 years old) and their primary caregiver. Each child completed standardized tests of executive function and visuospatial processing skills, Intelligence Quotient (IQ), and math achievement. Performance on executive function, IQ, math, and visuospatial processing tests was significantly lower in children with perinatal stroke when compared to normative means. Poorer inhibitory control was associated with worse math performance. Increased age at testing was associated with better performance on visuospatial ability (using standardized scores), and females performed better than males on a test of inhibitory control. Children with perinatal stroke displayed a range of neuropsychological impairments, and difficulties with executive function (inhibition) may contribute to math difficulties in this population.
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Affiliation(s)
- Eliza Li
- University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Smithson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Adam Kirton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - John Andersen
- University of Alberta, Edmonton, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | | | - Brian L. Brooks
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada,Faculty of Arts, University of Calgary, Calgary, Alberta, Canada,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Carmen Rasmussen
- University of Alberta, Edmonton, Alberta, Canada,Carmen Rasmussen, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 4-478, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
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Alshememry AK, Yang JLJ, Armstrong EA, Yager JY, Unsworth LD. Bacteriophage carriers localize in the brain of a rat model of neonatal hypoxic-ischemic encephalopathy. Biotechnol J 2021; 17:e2100226. [PMID: 34882965 DOI: 10.1002/biot.202100226] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neonatal hypoxic-ischemic encephalopathy arises from a reduction of oxygen and blood supply to the infant brain and can lead to severe brain damage and life-long disability. The damage is greatest at the irreversibly injured necrotic core, whereas the penumbra is the surrounding, potentially salvageable tissue populated with a mix of alive and dying cells. To date, there exists no method for targeting drugs to the brain damage. METHODS AND MAJOR RESULTS Bacteriophages are viruses that propagate in bacteria but are biocompatible in humans and also amenable to genetic and chemical modification in a manner distinctive from conventional therapeutic nanoparticles. Here, a library of M13 bacteriophage was administered into a rat model of hypoxic-ischemic encephalopathy, and unique bacteriophage clones were confirmed to localize in healthy brain tissue versus the core and penumbra zones of injury. CONCLUSIONS For the first time, there is a potential to directly deliver therapeutics to different regions of the neonatal brain injury.
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Affiliation(s)
- Abdullah K Alshememry
- Nanobiotechnology Unit, Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jung-Lynn Jonathan Yang
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Edward A Armstrong
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
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Virani S, Rasmussen C, Zivanovic N, Smithson L, Pei J, Andersen J, Yager JY, Kirton A, Brooks BL. Learning and memory profiles in youth with perinatal stroke: a study of the Child and Adolescent Memory Profile (ChAMP). Child Neuropsychol 2021; 28:99-106. [PMID: 34375160 DOI: 10.1080/09297049.2021.1957089] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is limited understanding of the effect of perinatal stroke on child and adolescent learning and memory abilities. This study sought to evaluate the clinical utility of the Child and Adolescent Memory Profile (ChAMP) in quantifying memory performance in youth with perinatal stroke. Children and adolescents aged 6-16 years old with a history of perinatal stroke (PS; n = 41) completed two subtests from the ChAMP (Lists and Objects). Age, sex, and ethnicity-matched healthy control (HC) data were obtained from the test publisher's standardization data set. Participants with a history of PS performed significantly worse (p < .05) with medium effect size (ƞp2 ≥ .06) than HC on the ChAMP Screening Index and on all ChAMP Lists and Objects scaled scores. Classification accuracy for the ChAMP scores ranged from 57% to 68% with the area under the curve ranging from .62-.75. No significant group differences on ChAMP performance (p > .05) were found for stroke side (left versus right-sided) or for seizure history (present versus absent). This study supports the utility of the ChAMP in perinatal stroke patients by demonstrating significantly worse performance in verbal and visual memory than HC. Classification accuracy is limited, but supportive for the Screening Index and Objects Delayed scores. The ChAMP may be a useful tool for evaluating cognition in this population when taken alongside the context of other tests, background history, and clinical observations.
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Affiliation(s)
- Shane Virani
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nikola Zivanovic
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lisa Smithson
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Adam Kirton
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Brian L Brooks
- Departments of Pediatrics, University of Calgary, Calgary, AB, Canada.,Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Psychology, University of Calgary, Calgary, AB, Canada
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Srivastava R, Shaw OEF, Armstrong E, Morneau-Jacob FD, Yager JY. Patterns of Brain Injury in Perinatal Arterial Ischemic Stroke and the Development of Infantile Spasms. J Child Neurol 2021; 36:583-588. [PMID: 33543672 DOI: 10.1177/0883073820986056] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Perinatal arterial ischemic stroke (PAIS) underlies approximately 10% of infantile spasms (IS). We aim to identify patterns of brain injury in ischemic stroke that may predispose infants to infantile spasms. METHODS Sixty-four perinatal arterial ischemic stroke patients were identified meeting the following inclusion criteria: term birth, magnetic resonance imaging (MRI) showing ischemic stroke or encephalomalacia in an arterial distribution, and follow-up records. Patients who developed infantile spasms (PAIS-IS) were analyzed descriptively for ischemic stroke injury patterns and were compared to a seizure-free control group (PAIS-only). Stroke injury was scored using the modified pediatric ASPECTS (modASPECTS). RESULTS The PAIS-IS (n = 9) group had significantly higher modASPECTS than the PAIS-only (n = 16) group (P = .002, Mann-Whitney). A greater proportion of PAIS-IS patients had injury to deep cerebral structures (67%) than PAIS-only (25%). CONCLUSION Infarct size was significantly associated with infantile spasms development. Results support theories implicating deep cerebral structures in infantile spasms pathogenesis. This may help identify perinatal arterial ischemic stroke patients at risk of infantile spasms, facilitating more timely diagnosis.
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Affiliation(s)
- Ratika Srivastava
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Oriana E F Shaw
- Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Edward Armstrong
- Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Francois-Dominique Morneau-Jacob
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, 25484University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Pediatric Neurosciences, Neuroscience and Mental Health Institute, Integrative Health Institute, Faculty of Medicine & Dentistry, Katz Group Centre for Pharmacy and Health Research, 25484University of Alberta, Edmonton, Alberta, Canada
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Yaworski AM, Yager JY, Richer L, Mailo J, Rajapakse T, Kassiri J. Improved care and management of paediatric neurological patients evaluated at a paediatric Rapid Access Neurology clinic: A pilot study. J Paediatr Child Health 2021; 57:908-912. [PMID: 33460255 DOI: 10.1111/jpc.15352] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/06/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
AIM Referral wait times for paediatric neurological patients are increasing, leading to an increased burden on the emergency department (ED). The paediatric Rapid Access Neurology (pRAN) clinic was created for paediatric patients who are clinically stable, but require an urgent paediatric neurology consultation. The objectives were to evaluate the pathways of referral, accuracy of referring diagnoses, adherence to clinic appointments, impact of clinic visitation on ED visits and patient satisfaction. METHODS Data were collected from the pRAN clinic from March 2018 until April 2019. Information was obtained from patient charts including the referring and final diagnosis, management plan and the number of visits made to the ED before and after visiting the pRAN clinic. RESULTS Of the 256 referred patients, 91 met inclusion criteria. The most frequent referral diagnosis was a seizure. Referring physicians and pRAN clinic neurologists differed significantly in the level of diagnostic agreement for patients <2 years of age (P = 0.03; 95% confidence interval (CI) -0.294, 0.373). There was a significant reduction in visits to the ED made by patients 3 months after the pRAN appointment compared with before the visit (P < 0.001; 95% CI -0.9070, -0.4088). The majority of patients felt that the clinic had high value and were satisfied with their follow-up plan. CONCLUSION This pilot study showed that a pRAN clinic can improve the accuracy of neurological diagnoses and management, especially for children <2 years of age. In addition, pRAN clinic patients make fewer subsequent visits to the ED and express high satisfaction with their care.
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Affiliation(s)
- Amanda M Yaworski
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lawrence Richer
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Janette Mailo
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Thilinie Rajapakse
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Janani Kassiri
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
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Ladak Z, Garcia E, Yoon J, Landry T, Armstrong EA, Yager JY, Persad S. Sulforaphane (SFA) protects neuronal cells from oxygen & glucose deprivation (OGD). PLoS One 2021; 16:e0248777. [PMID: 33735260 PMCID: PMC7971874 DOI: 10.1371/journal.pone.0248777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/04/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Perinatal brain injury results in neurodevelopmental disabilities (neuroDDs) that include cerebral palsy, autism, attention deficit disorder, epilepsy, learning disabilities and others. Commonly, injury occurs when placental circulation, that is responsible for transporting nutrients and oxygen to the fetus, is compromised. Placental insufficiency (PI) is a reduced supply of blood and oxygen to the fetus and results in a hypoxic-ischemic (HI) environment. A significant HI state in-utero leads to perinatal compromise, characterized by fetal growth restriction and brain injury. Given that over 80% of perinatal brain injuries that result in neuroDDs occur during gestation, prior to birth, preventive approaches are needed to reduce or eliminate the potential for injury and subsequent neuroDDs. Sulforaphane (SFA) derived from cruciferous vegetables such as broccoli sprouts (BrSps) is a phase-II enzyme inducer that acts via cytoplasmic Nrf2 to enhance the production of anti-oxidants in the brain through the glutathione pathway. We have previously shown a profound in vivo neuro-protective effect of BrSps/SFA as a dietary supplement in pregnant rat models of both PI and fetal inflammation. Strong evidence also points to a role for SFA as treatment for various cancers. Paradoxically, then SFA has the ability to enhance cell survival, and with conditions of cancer, enhance cell death. Given our findings of the benefit of SFA/Broccoli Sprouts as a dietary supplement during pregnancy, with improvement to the fetus, it is important to determine the beneficial and toxic dosing range of SFA. We therefore explored, in vitro, the dosing range of SFA for neuronal and glial protection and toxicity in normal and oxygen/glucose deprived (OGD) cell cultures. METHODS OGD simulates, in vitro, the condition experienced by the fetal brain due to PI. We developed a cell culture model of primary cortical neuronal, astrocyte and combined brain cell co-cultures from newborn rodent brains. The cultures were exposed to an OGD environment for various durations of time to determine the LD50 (duration of OGD required for 50% cell death). Using the LD50 as the time point, we evaluated the efficacy of varying doses of SFA for neuroprotective and neurotoxicity effects. Control cultures were exposed to normal media without OGD, and cytotoxicity of varying doses of SFA was also evaluated. Immunofluorescence (IF) and Western blot analysis of cell specific markers were used for culture characterization, and quantification of LD50. Efficacy and toxicity effect of SFA was assessed by IF/high content microscopy and by AlamarBlue viability assay, respectively. RESULTS We determined the LD50 to be 2 hours for neurons, 8 hours for astrocytes, and 10 hours for co-cultures. The protective effect of SFA was noticeable at 2.5 μM and 5 μM for neurons, although it was not significant. There was a significant protective effect of SFA at 2.5 μM (p<0.05) for astrocytes and co-cultures. Significant toxicity ranges were also confirmed in OGD cultures as ≥ 100 μM (p<0.05) for astrocytes, ≥ 50 μM (p<0.01) for co-cultures, but not toxic in neurons; and toxic in control cultures as ≥ 100 μM (p<0.01) for neurons, and ≥ 50 μM (p<0.01) for astrocytes and co-cultures. One Way ANOVA and Dunnett's Multiple Comparison Test were used for statistical analysis. CONCLUSIONS Our results indicate that cell death shows a trend to reduction in neuronal and astrocyte cultures, and is significantly reduced in co-cultures treated with low doses of SFA exposed to OGD. Doses of SFA that were 10 times higher were toxic, not only under conditions of OGD, but in normal control cultures as well. The findings suggest that: 1. SFA shows promise as a preventative agent for fetal ischemic brain injury, and 2. Because the fetus is a rapidly growing organism with profound cell multiplication, dosing parameters must be established to insure safety within efficacious ranges. This study will influence the development of innovative therapies for the prevention of childhood neuroDD.
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Affiliation(s)
- Zeenat Ladak
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth Garcia
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Yoon
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Takaaki Landry
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Edward A. Armstrong
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y. Yager
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sujata Persad
- Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Khan MH, Smithson L, Li E, Kirton A, Pei J, Andersen J, Yager JY, Brooks BL, Rasmussen C. Executive behavior and functional abilities in children with perinatal stroke and the associated caregiver impact. Child Neuropsychol 2020; 27:83-95. [PMID: 32718269 DOI: 10.1080/09297049.2020.1796953] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers' perception of executive behavior and functional abilities among children with perinatal stroke, and how these outcomes impact the caregivers. We administered three questionnaires to primary caregivers of children with perinatal stroke to obtain caregiver-reported measures of (1) executive behavior of their child (Behavior Rating Inventory of Executive Function, Second Edition), (2) the functional abilities of their child (Pediatric Evaluation of Disability Inventory Computer Adaptive Test), and (3) the psychosocial impact experienced by the caregiver themselves (Parental Outcome Measure). Participants included 20 children (mean age = 9.3 years, range = 6-16 years) with perinatal stroke and their primary caregivers. Functional abilities in the children were rated as clinically impaired in the domains of daily activities and mobility. Half of the children exhibited clinically impaired ratings on at least one executive behavior domain, but the mean scores for these domains did not reach clinically impaired levels. Greater ratings of problems in daily activities for the child was associated with greater caregiver guilt (r = -0.55, p = 0.02). Caregivers of children with perinatal stroke who experience limitations in performing daily activities should be more closely monitored for adverse impact and be provided the necessary support and education to alleviate the associated guilt.
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Affiliation(s)
- Muhammad H Khan
- Department of Pediatrics, University of Alberta , Edmonton, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Eliza Li
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary , Calgary, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta , Edmonton, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada.,Child Health, Glenrose Rehabilitation Hospital , Edmonton, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta , Edmonton, Canada.,Section of Pediatric Neurosciences, Stollery Children's Hospital , Edmonton, Canada
| | - Brian L Brooks
- Department of Pediatrics, University of Calgary , Calgary, Canada.,Neuropsychology Service, Alberta Children's Hospital , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine , Calgary, Canada.,Department of Psychology, University of Calgary , Calgary, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta , Edmonton, Canada
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11
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Jahandideh F, Bourque SL, Armstrong EA, Cherak SJ, Panahi S, Macala KF, Davidge ST, Yager JY. Late-pregnancy uterine artery ligation increases susceptibility to postnatal Western diet-induced fat accumulation in adult female offspring. Sci Rep 2020; 10:6926. [PMID: 32332768 PMCID: PMC7181802 DOI: 10.1038/s41598-020-63392-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/28/2020] [Indexed: 12/16/2022] Open
Abstract
Stressors during the fetal and postnatal period affect the growth and developmental trajectories of offspring, causing lasting effects on physiologic regulatory systems. Here, we tested whether reduced uterine artery blood flow in late pregnancy would alter body composition in the offspring, and whether feeding offspring a western diet (WD) would aggravate these programming effects. Pregnant rats underwent bilateral uterine artery ligation (BUAL) or sham surgery on gestational day (GD)18 (term = GD22). At weaning, offspring from each group received either a normal diet (ND) or a WD. BUAL surgery increased fetal loss and caused offspring growth restriction, albeit body weights were no longer different at weaning, suggesting postnatal catch-up growth. BUAL did not affect body weight gain, fat accumulation, or plasma lipid profile in adult male offspring. In contrast, while ND-fed females from BUAL group were smaller and leaner than their sham-littermates, WD consumption resulted in excess weight gain, fat accumulation, and visceral adiposity. Moreover, WD increased plasma triglycerides and cholesterol in the BUAL-treated female offspring without any effect on sham littermates. These results demonstrate that reduced uterine artery blood flow during late pregnancy in rodents can impact body composition in the offspring in a sex-dependent manner, and these effects may be exacerbated by postnatal chronic WD consumption.
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Affiliation(s)
- Forough Jahandideh
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Stephane L Bourque
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Edward A Armstrong
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stephana J Cherak
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sareh Panahi
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberly F Macala
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra T Davidge
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada. .,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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12
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Lu L, Armstrong EA, Yager JY, Unsworth LD. Sustained Release of Dexamethasone from Sulfobutyl Ether β-cyclodextrin Modified Self-Assembling Peptide Nanoscaffolds in a Perinatal Rat Model of Hypoxia-Ischemia. Adv Healthc Mater 2019; 8:e1900083. [PMID: 30977596 DOI: 10.1002/adhm.201900083] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/13/2019] [Indexed: 11/10/2022]
Abstract
Inflammation plays a critical role in the development of hypoxia-ischemia (HI) induced newborn brain damage. A localized, sustained delivery of dexamethasone (Dex) through an intracerebral injection could reduce the inflammatory response in the injured perinatal brain while avoiding unnecessary side effects. Herein, investigated using anionic sulfobutyl ether β-cyclodextrin (SBE-β-CD) to load Dex in the (RADA)4 nanofiber networks as a means of reducing the inflammatory response to HI injury is investigated. The ionic interaction between SBE-β-CD and (RADA)4 dramatically affects nanofiber formation and the stability of the nanoscaffold is highly dependent on the SBE-β-CD/(RADA)4 ratio. It is observed that the Dex release rate is affected by the concentration of SBE-β-CD and (RADA)4 peptide. A higher concentration of SBE-β-CD or (RADA)4 results in a higher drug encapsulation efficiency and slower release rate of Dex. This phenomenon may be related to the structure of fiber bundles. Animal studies show that nanoscaffold loaded with Dex inhibits both microglia activation and glial scar formation compared to controls (Dex alone or nanoscaffold alone) within 2 days of injury. It is thought that this is a step toward building a multifaceted nanoscaffold that can be used to treat HI events in perinates.
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Affiliation(s)
- Lei Lu
- School of Life Science and EngineeringSouthwest Jiaotong University Chengdu Sichuan 611756 China
- Department of Chemical and Materials EngineeringUniversity of Alberta Edmonton Alberta T6G 2V4 Canada
| | - Edward A. Armstrong
- Department of PediatricsDivision of Pediatric NeurosciencesUniversity of Alberta Edmonton Alberta T6G 1C9 Canada
| | - Jerome Y. Yager
- Department of PediatricsDivision of Pediatric NeurosciencesUniversity of Alberta Edmonton Alberta T6G 1C9 Canada
| | - Larry D. Unsworth
- Department of Chemical and Materials EngineeringUniversity of Alberta Edmonton Alberta T6G 2V4 Canada
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Srivastava R, Shaw O, Armstrong E, Morneau-Jacob FD, Yager JY. Abstract TP509: Patterns of Injury in Children With Perinatal Arterial Ischemic Stroke and Infantile Spasms. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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]
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14
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Yager JY. Glucose and Perinatal Brain Injury—Questions and Controversies. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00009-1] [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: 11/17/2022] Open
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15
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Abu-Sa'da OS, Armstrong EA, Scott O, Shaw O, Nguyen AT, Shen K, Cheung PY, Baker G, Yager JY. The Effect of Caffeine on the Neuropathological and Neurobehavioral Outcome in the Newborn Rat. J Caffeine Adenosine Res 2018. [DOI: 10.1089/caff.2017.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar S. Abu-Sa'da
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Neonatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Edward A. Armstrong
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry, Centre for Neuroscience, University of Alberta, Edmonton, Canada
| | - Ori Scott
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Oriana Shaw
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Antoinette T. Nguyen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry, Centre for Neuroscience, University of Alberta, Edmonton, Canada
| | - Keqin Shen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Pediatric Neurosciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Neonatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Glen Baker
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jerome Y. Yager
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Medicine and Dentistry, Centre for Neuroscience, University of Alberta, Edmonton, Canada
- Department of Pediatric Neurosciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Abstract
OBJECTIVE Health-related quality of life (HRQL) instruments are patient or proxy-reported outcome measures that provide a comprehensive and subjective assessment of patient's well-being and hence vital for health outcomes evaluation. A clear and thorough understanding of HRQL and its determinants is especially important to appropriately guide health-improving interventions. In this study, HRQL of paediatric arterial ischaemic stroke survivors was assessed using guidelines recommended for interpretation and reporting of the patient-reported outcome data. Determinants of HRQL were also explored. METHODS Children diagnosed with arterial ischaemic stroke between 2003 and 2012 were assessed at least 1 year poststroke using the parent-proxy report versions of the Pediatric Quality of Life Inventory 4.0 and Pediatric Stroke Recurrence and Recovery Questionnaire. HRQL data were compared with population norms and used as outcome in multiple linear regression analysis. RESULTS 59 children were evaluated. Mean age at diagnosis of stroke was 2.2 years. Mean age at assessment and time elapsed since stroke was 7 years and 5 years, respectively. A total of 41% children had normal global outcome, whereas 51% had moderate to severe deficits. A lower overall HRQL was observed in both self and proxy reports. Parents reported the maximum impairment in emotional domain, whereas children indicated physical functioning to be the most affected. Neurological outcome, site of stroke and socioeconomic status were independently associated with overall HRQL. CONCLUSIONS Lower HRQL was demonstrated in children who survived arterial ischaemic stroke. Socioeconomic status of families was an important determinant of HRQL, over and above clinical parameters.
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Affiliation(s)
- Satvinder K Ghotra
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Weiyu Qiu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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17
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Ruff CA, Faulkner SD, Rumajogee P, Beldick S, Foltz W, Corrigan J, Basilious A, Jiang S, Thiyagalingam S, Yager JY, Fehlings MG. The extent of intrauterine growth restriction determines the severity of cerebral injury and neurobehavioural deficits in rodents. PLoS One 2017; 12:e0184653. [PMID: 28934247 PMCID: PMC5608203 DOI: 10.1371/journal.pone.0184653] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/28/2017] [Indexed: 12/16/2022] Open
Abstract
Background Cerebral Palsy (CP) is the most common physical pediatric neurodevelopmental disorder and spastic diplegic injury is its most frequent subtype. CP results in substantial neuromotor and cognitive impairments that have significant socioeconomic impact. Despite this, its underlying pathophysiological mechanisms and etiology remain incompletely understood. Furthermore, there is a need for clinically relevant injury models, which a) reflect the heterogeneity of the condition and b) can be used to evaluate new translational therapies. To address these key knowledge gaps, we characterized a chronic placental insufficiency (PI) model, using bilateral uterine artery ligation (BUAL) of dams. This injury model results in intrauterine growth restriction (IUGR) in pups, and animals recapitulate the human phenotype both in terms of neurobehavioural and anatomical deficits. Methods Effects of BUAL were studied using luxol fast blue (LFB)/hematoxylin & eosin (H&E) staining, immunohistochemistry, quantitative Magnetic Resonance Imaging (MRI), and Catwalk neurobehavioural tests. Results Neuroanatomical analysis revealed regional ventricular enlargement and corpus callosum thinning in IUGR animals, which was correlated with the extent of growth restriction. Olig2 staining revealed reductions in oligodendrocyte density in white and grey matter structures, including the corpus callosum, optic chiasm, and nucleus accumbens. The caudate nucleus, along with other brain structures such as the optic chiasm, internal capsule, septofimbrial and lateral septal nuclei, exhibited reduced size in animals with IUGR. The size of the pretectal nucleus was reduced only in moderately injured animals. MAG/NF200 staining demonstrated reduced myelination and axonal counts in the corpus callosum of IUGR animals. NeuN staining revealed changes in neuronal density in the hippocampus and in the thickness of hippocampal CA2 and CA3 regions. Diffusion weighted imaging (DWI) revealed regional white and grey matter changes at 3 weeks of age. Furthermore, neurobehavioural testing demonstrated neuromotor impairments in animals with IUGR in paw intensities, swing speed, relative print positions, and phase dispersions. Conclusions We have characterized a rodent model of IUGR and have demonstrated that the neuroanatomical and neurobehavioural deficits mirror the severity of the IUGR injury. This model has the potential to be applied to examine the pathobiology of and potential therapeutic strategies for IUGR-related brain injury. Thus, this work has potential translational relevance for the study of CP.
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Affiliation(s)
- Crystal A. Ruff
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart D. Faulkner
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prakasham Rumajogee
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Beldick
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Warren Foltz
- STARR facility, Toronto Medical Discovery Tower, Toronto, Ontario, Canada
| | - Jennifer Corrigan
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Alfred Basilious
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shangjun Jiang
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shanojan Thiyagalingam
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jerome Y. Yager
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael G. Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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18
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Lowe DW, Hollis BW, Wagner CL, Bass T, Kaufman DA, Horgan MJ, Givelichian LM, Sankaran K, Yager JY, Katikaneni LD, Wiest D, Jenkins D. Vitamin D insufficiency in neonatal hypoxic-ischemic encephalopathy. Pediatr Res 2017; 82:55-62. [PMID: 28099429 PMCID: PMC5509506 DOI: 10.1038/pr.2017.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/26/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin D has neuroprotective and immunomodulatory properties, and deficiency is associated with worse stroke outcomes. Little is known about effects of hypoxia-ischemia or hypothermia treatment on vitamin D status in neonates with hypoxic-ischemic encephalopathy (HIE). We hypothesized vitamin D metabolism would be dysregulated in neonatal HIE altering specific cytokines involved in Th17 activation, which might be mitigated by hypothermia. METHODS We analyzed short-term relationships between 25(OH) and 1,25(OH)2 vitamin D, vitamin D binding protein, and cytokines related to Th17 function in serum samples from a multicenter randomized controlled trial of hypothermia 33 °C for 48 h after HIE birth vs. normothermia in 50 infants with moderate to severe HIE. RESULTS Insufficiency of 25(OH) vitamin D was observed after birth in 70% of infants, with further decline over the first 72 h, regardless of treatment. 25(OH) vitamin D positively correlated with anti-inflammatory cytokine IL-17E in all HIE infants. However, Th17 cytokine suppressor IL-27 was significantly increased by hypothermia, negating the IL-27 correlation with vitamin D observed in normothermic HIE infants. CONCLUSION Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates and is related to lower circulating anti-inflammatory IL-17E. Hypothermia does not mitigate vitamin D deficiency in HIE.
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Affiliation(s)
- Danielle W Lowe
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Bruce W Hollis
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Thomas Bass
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - David A Kaufman
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Michael J Horgan
- Department of Pediatrics, Albany Medical Center, Albany, New York, USA
| | | | | | - Jerome Y. Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Don Wiest
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Dorothea Jenkins
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC,Corresponding author and reprint requests: Dorothea Jenkins, MD, Department of Pediatrics MSC 917, Medical University of South Carolina, 165 Ashley Ave., Charleston, SC 29425, Office phone 1-843-792-2112,
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19
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Abstract
Neurodevelopmental reflex testing is commonly used in clinical practice to assess the maturation of the nervous system. Neurodevelopmental reflexes are also referred to as primitive reflexes. They are sensitive and consistent with later outcomes. Abnormal reflexes are described as an absence, persistence, reappearance, or latency of reflexes, which are predictive indices of infants that are at high risk for neurodevelopmental disorders. Animal models of neurodevelopmental disabilities, such as cerebral palsy, often display aberrant developmental reflexes, as would be observed in human infants. The techniques described assess a variety of neurodevelopmental reflexes in neonatal rats. Neurodevelopmental reflex testing offers the investigator a testing method that is not otherwise available in such young animals. The methodology presented here aims to assist investigators in examining developmental milestones in neonatal rats as a method of detecting early-onset brain injury and/or determining the effectiveness of therapeutic interventions. The methodology presented here aims to provide a general guideline for investigators.
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20
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deVeber GA, Kirton A, Booth FA, Yager JY, Wirrell EC, Wood E, Shevell M, Surmava AM, McCusker P, Massicotte MP, MacGregor D, MacDonald EA, Meaney B, Levin S, Lemieux BG, Jardine L, Humphreys P, David M, Chan AKC, Buckley DJ, Bjornson BH. Epidemiology and Outcomes of Arterial Ischemic Stroke in Children: The Canadian Pediatric Ischemic Stroke Registry. Pediatr Neurol 2017; 69:58-70. [PMID: 28254555 DOI: 10.1016/j.pediatrneurol.2017.01.016] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric arterial ischemic stroke remains incompletely understood. Population-based epidemiological data inform clinical trial design but are scant in this condition. We aimed to determine age-specific epidemiological characteristics of arterial ischemic stroke in neonates (birth to 28 days) and older children (29 days to 18 years). METHODS We conducted a 16-year, prospective, national population-based study, the Canadian Pediatric Ischemic Stroke Registry, across all 16 Canadian acute care children's hospitals. We prospectively enrolled children with arterial ischemic stroke from January 1992 to December 2001 and documented disease incidence, presentations, risk factors, and treatments. Study outcomes were assessed throughout 2008, including abnormal clinical outcomes (stroke-related death or neurological deficit) and recurrent arterial ischemic stroke or transient ischemic attack. RESULTS Among 1129 children enrolled with arterial ischemic stroke, stroke incidence was 1.72/100,000/year, (neonates 10.2/100,000 live births). Detailed clinical and radiological information were available for 933 children (232 neonates and 701 older children, 55% male). The predominant clinical presentations were seizures in neonates (88%), focal deficits in older children (77%), and diffuse neurological signs (54%) in both. Among neonates, 44% had no discernible risk factors. In older children, arteriopathy (49% of patients with vascular imaging), cardiac disorders (28%), and prothrombotic disorders (35% of patients tested) predominated. Antithrombotic treatment increased during the study period (P < 0.001). Stroke-specific mortality was 5%. Outcomes included neurological deficits in 60% of neonates and 70% of older children. Among neonates, deficits emerged during follow-up in 39%. Overall, an initially decreased level of consciousness, a nonspecific systemic presentation, and the presence of stroke risk factors predicted abnormal outcomes. For neonates, predictors were decreased level of consciousness, nonspecific systemic presentation, and basal ganglia infarcts. For older children, predictors were initial seizures, nonspecific systemic presentation, risk factors, and lack of antithrombotic treatment. Recurrent arterial ischemic stroke or transient ischemic attack developed in 12% of older children and was predicted by arteriopathy, presentation without seizures, and lack of antithrombotic treatment. Emerging deficit was predicted by neonatal age at stroke and by cardiac disease. CONCLUSIONS This national data set provides a population-based disease incidence rate and demonstrates the protective effect of antithrombotic treatment in older children, and frequent long-term emerging deficits in neonates and in children with cardiac disorders. Further clinical trials are required to develop effective age-appropriate treatments for children with acute arterial ischemic stroke.
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Affiliation(s)
- Gabrielle A deVeber
- Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Adam Kirton
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Frances A Booth
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Ellen Wood
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Ann-Marie Surmava
- Division of Neurology, Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia McCusker
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Daune MacGregor
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - E Athen MacDonald
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Brandon Meaney
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Simon Levin
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Bernard G Lemieux
- Department of Pediatrics, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lawrence Jardine
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Peter Humphreys
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michèle David
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Anthony K C Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - David J Buckley
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland, Canada
| | - Bruce H Bjornson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Rashid M, Goez HR, Caine V, Yager JY, Joyce AS, Newton AS. After a child's acquired brain injury (ABI): An ethnographic study of being a parent. J Pediatr Rehabil Med 2016; 9:303-313. [PMID: 27935570 DOI: 10.3233/prm-160403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore the meanings associated with being a parent of a child with an aquired brain injury (ABI). METHODS An ethnographic study was conducted with parents of children aged 3 to 10 years who had acquired a severe brain injury. Purposeful sampling was used to recruit parents from the Glenrose Rehabilitation Hospital in Edmonton, Alberta. Data collection involved participant observation, fieldwork and semi-structured interviews. Field notes and interviews transcriptions were analysed using a thematic analysis framework and informed by symbolic interactionism theory. RESULTS Six parent dyads (mothers and fathers) and 4 mothers participated in the study.Parents' meanings of `parenting' a child with severe brain injury were shaped by the injury, wide range of familial dynamics, and interactions. Six main themes related to parental meanings emerged from our data: (1) Getting `back to normal'; (2) Relying on a support system; (3) Worrying something bad may happen after the injury; (4) Going through a range of emotions following the injury; (5) Changing family dynamics after the injury; and (6) Ongoing performativity. CONCLUSION Parents' meanings of `parenting' a child are extensively impacted by their child's functioning after the ABI. Having a greater appreciation of these experiences may be beneficial for medical professionals.
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Affiliation(s)
- Marghalara Rashid
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Helly R Goez
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anthony S Joyce
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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22
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Fullerton HJ, deVeber GA, Hills NK, Dowling MM, Fox CK, Mackay MT, Kirton A, Yager JY, Bernard TJ, Hod EA, Wintermark M, Elkind MSV. Inflammatory Biomarkers in Childhood Arterial Ischemic Stroke: Correlates of Stroke Cause and Recurrence. Stroke 2016; 47:2221-8. [PMID: 27491741 DOI: 10.1161/strokeaha.116.013719] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 04/20/2016] [Accepted: 06/21/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Among children with arterial ischemic stroke (AIS), those with arteriopathy have the highest recurrence risk. We hypothesized that arteriopathy progression is an inflammatory process and that inflammatory biomarkers would predict recurrent AIS. METHODS In an international study of childhood AIS, we selected cases classified into 1 of the 3 most common childhood AIS causes: definite arteriopathic (n=103), cardioembolic (n=55), or idiopathic (n=78). We measured serum concentrations of high-sensitivity C-reactive protein, serum amyloid A, myeloperoxidase, and tumor necrosis factor-α. We used linear regression to compare analyte concentrations across the subtypes and Cox proportional hazards models to determine predictors of recurrent AIS. RESULTS Median age at index stroke was 8.2 years (interquartile range, 3.6-14.3); serum samples were collected at median 5.5 days post stroke (interquartile range, 3-10 days). In adjusted models (including age, infarct volume, and time to sample collection) with idiopathic as the reference, the cardioembolic (but not arteriopathic) group had higher concentrations of high-sensitivity C-reactive protein and myeloperoxidase, whereas both cardioembolic and arteriopathic groups had higher serum amyloid A. In the arteriopathic (but not cardioembolic) group, higher high-sensitivity C-reactive protein and serum amyloid A predicted recurrent AIS. Children with progressive arteriopathies on follow-up imaging had higher recurrence rates, and a trend toward higher high-sensitivity C-reactive protein and serum amyloid A, compared with children with stable or improved arteriopathies. CONCLUSIONS Among children with AIS, specific inflammatory biomarkers correlate with cause and-in the arteriopathy group-risk of stroke recurrence. Interventions targeting inflammation should be considered for pediatric secondary stroke prevention trials.
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Affiliation(s)
- Heather J Fullerton
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Gabrielle A deVeber
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Nancy K Hills
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Michael M Dowling
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Christine K Fox
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Mark T Mackay
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Adam Kirton
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Jerome Y Yager
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Timothy J Bernard
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Eldad A Hod
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Max Wintermark
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.)
| | - Mitchell S V Elkind
- From the Departments of Neurology (H.J.F., N.K.H., C.K.F.), Pediatrics (H.J.F., C.K.F.), and Biostatistics and Epidemiology (N.K.H.), University of California San Francisco; Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.A.d.); Departments of Pediatrics and Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX (M.M.D.); Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Victoria, Australia (M.T.M.); Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada (A.K.); Department of Pediatrics, University of Alberta, Edmonton, Canada (J.Y.Y.); Department of Pediatrics, University of Colorado, Denver (T.J.B.); Departments of Pathology (E.A.H.) and Neurology (M.S.V.E.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, New York, NY (M.S.V.E.); and Department of Radiology, Stanford University, Palo Alto, CA (M.W.).
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Rumajogee P, Bregman T, Miller SP, Yager JY, Fehlings MG. Rodent Hypoxia-Ischemia Models for Cerebral Palsy Research: A Systematic Review. Front Neurol 2016; 7:57. [PMID: 27199883 PMCID: PMC4843764 DOI: 10.3389/fneur.2016.00057] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/03/2016] [Indexed: 12/28/2022] Open
Abstract
Cerebral palsy (CP) is a complex multifactorial disorder, affecting approximately 2.5-3/1000 live term births, and up to 22/1000 prematurely born babies. CP results from injury to the developing brain incurred before, during, or after birth. The most common form of this condition, spastic CP, is primarily associated with injury to the cerebral cortex and subcortical white matter as well as the deep gray matter. The major etiological factors of spastic CP are hypoxia/ischemia (HI), occurring during the last third of pregnancy and around birth age. In addition, inflammation has been found to be an important factor contributing to brain injury, especially in term infants. Other factors, including genetics, are gaining importance. The classic Rice-Vannucci HI model (in which 7-day-old rat pups undergo unilateral ligation of the common carotid artery followed by exposure to 8% oxygen hypoxic air) is a model of neonatal stroke that has greatly contributed to CP research. In this model, brain damage resembles that observed in severe CP cases. This model, and its numerous adaptations, allows one to finely tune the injury parameters to mimic, and therefore study, many of the pathophysiological processes and conditions observed in human patients. Investigators can recreate the HI and inflammation, which cause brain damage and subsequent motor and cognitive deficits. This model further enables the examination of potential approaches to achieve neural repair and regeneration. In the present review, we compare and discuss the advantages, limitations, and the translational value for CP research of HI models of perinatal brain injury.
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Affiliation(s)
- Prakasham Rumajogee
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network , Toronto, ON , Canada
| | - Tatiana Bregman
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network , Toronto, ON , Canada
| | - Steven P Miller
- Department of Pediatrics, Hospital for Sick Children , Toronto, ON , Canada
| | - Jerome Y Yager
- Division of Pediatric Neurosciences, Stollery Children's Hospital, University of Alberta , Edmonton, AB , Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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24
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van der Veen JN, Lingrell S, Gao X, Quiroga AD, Takawale A, Armstrong EA, Yager JY, Kassiri Z, Lehner R, Vance DE, Jacobs RL. Pioglitazone attenuates hepatic inflammation and fibrosis in phosphatidylethanolamine N-methyltransferase-deficient mice. Am J Physiol Gastrointest Liver Physiol 2016; 310:G526-38. [PMID: 26797396 DOI: 10.1152/ajpgi.00243.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 07/16/2015] [Accepted: 12/21/2015] [Indexed: 01/31/2023]
Abstract
Phosphatidylethanolamine N-methyltransferase (PEMT) is an important enzyme in hepatic phosphatidylcholine (PC) biosynthesis. Pemt(-/-) mice are protected against high-fat diet (HFD)-induced obesity and insulin resistance; however, these mice develop nonalcoholic fatty liver disease (NAFLD). We hypothesized that peroxisomal proliferator-activated receptor-γ (PPARγ) activation by pioglitazone might stimulate adipocyte proliferation, thereby directing lipids from the liver toward white adipose tissue. Pioglitazone might also act directly on PPARγ in the liver to improve NAFLD. Pemt(+/+) and Pemt(-/-) mice were fed a HFD with or without pioglitazone (20 mg·kg(-1)·day(-1)) for 10 wk. Pemt(-/-) mice were protected from HFD-induced obesity but developed NAFLD. Treatment with pioglitazone caused an increase in body weight gain in Pemt(-/-) mice that was mainly due to increased adiposity. Moreover, pioglitazone improved NAFLD in Pemt(-/-) mice, as indicated by a 35% reduction in liver weight and a 57% decrease in plasma alanine transaminase levels. Livers from HFD-fed Pemt(-/-) mice were steatotic, inflamed, and fibrotic. Hepatic steatosis was still evident in pioglitazone-treated Pemt(-/-) mice; however, treatment with pioglitazone reduced hepatic fibrosis, as evidenced by reduced Sirius red staining and lowered mRNA levels of collagen type Iα1 (Col1a1), tissue inhibitor of metalloproteinases 1 (Timp1), α-smooth muscle actin (Acta2), and transforming growth factor-β (Tgf-β). Similarly, oxidative stress and inflammation were reduced in livers from Pemt(-/-) mice upon treatment with pioglitazone. Together, these data show that activation of PPARγ in HFD-fed Pemt(-/-) mice improved liver function, while these mice were still protected against diet-induced obesity and insulin resistance.
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Affiliation(s)
- Jelske N van der Veen
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Susanne Lingrell
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Xia Gao
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ariel D Quiroga
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Abhijit Takawale
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Edward A Armstrong
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Zamaneh Kassiri
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Richard Lehner
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Dennis E Vance
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - René L Jacobs
- Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, Canada; Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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25
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Nguyen AT, Bahry AMA, Shen KQ, Armstrong EA, Yager JY. Consumption of broccoli sprouts during late gestation and lactation confers protection against developmental delay induced by maternal inflammation. Behav Brain Res 2016; 307:239-49. [PMID: 27038765 DOI: 10.1016/j.bbr.2016.03.017] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The presence of a fetal inflammatory response is linked to cerebral palsy. Unfortunately no preventive therapies are available. In this study, we determined whether dietary supplementation with broccoli sprouts (BrSp), a phase-II enzyme inducer, would be effective in preventing the behavioural and pathologic manifestations in a rodent model of inflammation during late pregnancy. METHODS Pregnant Long-Evans rats were administered i.p. Injections of saline (100μl) or lipopolysaccharide (LPS, 200μg/kg), every 12h on embryonic day (E) 19 and 20. In the treatment groups, dams were supplemented with 200mg/day of dried BrSp from E14 until postnatal day 21. Pups underwent a series of neurodevelopmental reflex tests from postnatal day 3-21 followed by neuropathological analyses. RESULTS Pups born from the LPS group were significantly growth restricted (p<0.001) and delayed in hindlimb placing (p<0.05), cliff avoidance (p<0.05), and gait (p<0.001) compared to controls. In the open field behaviour analyses, LPS pups had an increase in grooming behaviour (p<0.05) and a decreased amount of time spent in the center of the box compared to controls. Dietary supplementation with BrSp to offspring exposed to LPS had increased birth weights (p<0.001), were no longer delayed in acquiring hindlimb placing, cliff avoidance, gait, and posture, and groomed less compared to LPS alone pups (p<0.01). Histological analyses revealed that LPS pups had reduced myelin basic protein compared to controls. CONCLUSIONS Our data suggest that BrSp dietary supplementation during pregnancy may be effective in preventing growth restriction and neurodevelopmental delays.
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Affiliation(s)
| | - Ashley M A Bahry
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ke Qin Shen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Edward A Armstrong
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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26
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Abstract
The acronym PHACE has been used to denote a constellation of abnormalities: posterior fossa anomalies, facial hemangiomas, arterial anomalies, cardiac anomalies, and eye abnormalities. Approximately 30% of patients with large facial hemangiomas have PHACE syndrome, with the vast majority having intracranial arteriopathy. Few reports characterize neurological deterioration from this intracranial arteriopathy, and even fewer report successful treatment thereof. The authors report on a case of a child with PHACE syndrome who presented with an ischemic stroke from a progressive intracranial arteriopathy and describe her successful treatment with bilateral pial synangiosis. An 8-month old girl diagnosed with PHACE syndrome was found to have bilateral internal carotid artery stenosis. Although initially asymptomatic, a few months after diagnosis she suffered a right frontal and parietal stroke. MRI and cerebral angiography investigations demonstrated progressive intracranial arterial stenosis and occlusion. The patient then underwent indirect cerebral revascularization surgery. At 2-year follow-up, she exhibited clinical improvement with persistent speech and motor developmental delay. Follow-up MRI and cerebral angiography showed no new ischemic events and robust extensive vascular collateralization from surgery. PHACE syndrome is an uncommon disease, and affected patients often have cerebral arteriopathy. Although the underlying natural history of cerebral arteriopathy in PHACE remains unclear, cerebral revascularization may represent a potential therapy for symptomatic patients.
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Affiliation(s)
- Andrew S Jack
- Division of Neurosurgery, Department of Surgery, and
| | | | | | | | - Jerome Y Yager
- Pediatric Neurology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Vivek Mehta
- Division of Neurosurgery, Department of Surgery, and
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27
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Przyslupski A, Armstrong E, Shen K, Yager JY. ISDN2014_0189: Sulforaphane is not additive in combination with hypothermia in a neonatal rat model of hypoxia–ischemia. Int J Dev Neurosci 2015. [DOI: 10.1016/j.ijdevneu.2015.04.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ann‐Marie Przyslupski
- Department of Pediatrics, Faculty of Medicine and DentistryUniversity of AlbertaCanada
| | - Edward Armstrong
- Department of Pediatrics, Faculty of Medicine and DentistryUniversity of AlbertaCanada
| | - Keqin Shen
- Department of Pediatrics, Faculty of Medicine and DentistryUniversity of AlbertaCanada
| | - Jerome Y. Yager
- Department of Pediatrics, Faculty of Medicine and DentistryUniversity of AlbertaCanada
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28
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Nguyen A, Peart T, Bahry A, Armstrong E, Cheung P, Schulz R, Yager JY. ISDN2014_0147: The use of broccoli sprouts as a neuropreventative agent in a neonatal rat model of the fetal inflammatory response. Int J Dev Neurosci 2015. [DOI: 10.1016/j.ijdevneu.2015.04.121] [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: 10/22/2022] Open
Affiliation(s)
| | | | - Ashley Bahry
- Department of PediatricsUniversity of AlbertaCanada
| | | | - Po‐Yin Cheung
- Department of PediatricsUniversity of AlbertaCanada
- Department of PharmacologyUniversity of AlbertaCanada
- Department of SurgeryUniversity of AlbertaCanada
| | - Richard Schulz
- Department of PediatricsUniversity of AlbertaCanada
- Department of PharmacologyUniversity of AlbertaCanada
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29
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Ghotra SK, Johnson JA, Qiu W, Newton A, Rasmussen C, Yager JY. Age at stroke onset influences the clinical outcome and health-related quality of life in pediatric ischemic stroke survivors. Dev Med Child Neurol 2015; 57:1027-34. [PMID: 26307431 DOI: 10.1111/dmcn.12870] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Accepted: 07/09/2015] [Indexed: 12/25/2022]
Abstract
AIM Stroke in children occurs across different phases of brain development. Age at onset may affect outcome and health-related quality of life (HRQL). We evaluated the influence of age at stroke onset on the long-term neurological outcomes and HRQL of pediatric stroke survivors. METHOD Children with ischemic stroke were recruited into three groups according to their age at onset of stroke (presumed perinatal, neonatal, and childhood). Neurological outcomes were assessed using the Pediatric Stroke Recovery and Recurrence Questionnaire. HRQL was evaluated using proxy report versions (2-18y) of the Pediatric Quality of Life Inventory (PedsQL 4.0). A χ(2) /Fisher's exact test and multivariable logistic regression analysis was performed for the neurological outcomes. HRQL scores from the different age groups were compared using linear regression. RESULTS Ninety participants (presumed perinatal stroke, n=31; neonatal stroke, n=36; childhood stroke, n=23) were enrolled. Median age at the onset of stroke was 0.5 days and 3.7 years in neonatal and childhood participants respectively. Of the three groups, participants with presumed perinatal stroke demonstrated the worst global (p<0.002) and motor (p<0.001) outcomes and the lowest level of independence in daily activities (p<0.001). Parents reported the best global outcome and overall HRQL (p=0.007) after neonatal stroke. INTERPRETATION The age at stroke onset has important implications regarding long-term clinical outcomes and HRQL for survivors. Individuals with presumed perinatal stroke should be considered at high-risk for poor outcomes.
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Affiliation(s)
| | - Jeffrey A Johnson
- Faculty of Public Health Sciences, University of Alberta, Edmonton, AL, Canada
| | - Weiyu Qiu
- Faculty of Public Health Sciences, University of Alberta, Edmonton, AL, Canada
| | - Amanda Newton
- Department of Pediatrics, University of Alberta, Edmonton, AL, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AL, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, AL, Canada
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Black AM, Armstrong EA, Scott O, Juurlink BJH, Yager JY. Broccoli sprout supplementation during pregnancy prevents brain injury in the newborn rat following placental insufficiency. Behav Brain Res 2015; 291:289-298. [PMID: 26014855 DOI: 10.1016/j.bbr.2015.05.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 10/23/2014] [Revised: 05/13/2015] [Accepted: 05/16/2015] [Indexed: 11/29/2022]
Abstract
Chronic placental insufficiency and subsequent intrauterine growth restriction (IUGR) increase the risk of hypoxic-ischemic encephalopathy in the newborn by 40 fold. The latter, in turn, increases the risk of cerebral palsy and developmental disabilities. This study seeks to determine the effectiveness of broccoli sprouts (BrSp), a rich source of the isothiocyanate sulforaphane, as a neuroprotectant in a rat model of chronic placental insufficiency and IUGR. Placental insufficiency and IUGR was induced by bilateral uterine artery ligation (BUAL) on day E20 of gestation. Dams were fed standard chow or chow supplemented with 200mg of dried BrSp from E15 - postnatal day 14 (PD14). Controls received Sham surgery and the same dietary regime. Pups underwent neurologic reflex testing and open field testing, following which they were euthanized and their brains frozen for neuropathologic assessment. Compared to Sham, IUGR pups were delayed in attaining early reflexes and performed worse in the open field, both of which were significantly improved by maternal supplementation of BrSp (p<0.05). Neuropathology revealed diminished white matter, ventricular dilation, astrogliosis and reduction in hippocampal neurons in IUGR animals compared to Sham, whereas broccoli sprout supplementation improved outcome in all histological assessments (p<0.05). Maternal dietary supplementation with BrSp prevented the detrimental neurocognitive and neuropathologic effects of chronic intrauterine ischemia. These findings suggest a novel approach for prevention of cerebral palsy and/or developmental disabilities associated with placental insufficiency.
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Affiliation(s)
- A M Black
- Pediatric Neurosciences, Department of Pediatrics and Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - E A Armstrong
- Pediatric Neurosciences, Department of Pediatrics and Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - O Scott
- Pediatric Neurosciences, Department of Pediatrics and Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - B J H Juurlink
- Department of Anatomy and Cell Biology, University of Saskatchewan, Saskatchewan, Canada
| | - J Y Yager
- Pediatric Neurosciences, Department of Pediatrics and Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada.
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Bell E, Rasmussen LA, Mazer B, Shevell M, Miller SP, Synnes A, Yager JY, Majnemer A, Muhajarine N, Chouinard I, Racine E. Magnetic resonance imaging (MRI) and prognostication in neonatal hypoxic-ischemic injury: a vignette-based study of Canadian specialty physicians. J Child Neurol 2015; 30:174-81. [PMID: 24789518 DOI: 10.1177/0883073814531821] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) could improve prognostication in neonatal brain injury; however, factors beyond technical or scientific refinement may impact its use and interpretation. We surveyed Canadian neonatologists and pediatric neurologists using general and vignette-based questions about the use of MRI for prognostication in neonates with hypoxic-ischemic injury. There was inter- and intra-vignette variability in prognosis and in ratings about the usefulness of MRI. Severity of predicted outcome correlated with certainty about the outcome. A majority of physicians endorsed using MRI results in discussing prognosis with families, and most suggested that MRI results contribute to end-of-life decisions. Participating neonatologists, when compared to participating pediatric neurologists, had significantly less confidence in the interpretation of MRI by colleagues in neurology and radiology. Further investigation is needed to understand the complexity of MRI and of its application. Potential gaps relative to our understanding of the ethical importance of these findings should be addressed.
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Affiliation(s)
- Emily Bell
- Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada
| | | | - Barbara Mazer
- Jewish Rehabilitation Hospital of Laval, Laval, Quebec, Canada
| | | | | | - Anne Synnes
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Eric Racine
- Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada McGill University, Montreal, Quebec, Canada Université de Montréal, Montréal, Quebec, Canada
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Racine E, Bell E, Yan A, Andrew G, Bell LE, Clarke M, Dubljevic V, Goldowitz D, Janvier A, McLachlan K, Muhajarine N, Nicholas D, Oskoui M, Rasmussen C, Rasmussen LA, Roberts W, Shevell M, Wade L, Yager JY. Ethics challenges of transition from paediatric to adult health care services for young adults with neurodevelopmental disabilities. Paediatr Child Health 2014; 19:65-8. [PMID: 24596475 DOI: 10.1093/pch/19.2.65] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Racine
- Neuroethics Research Unit; ; Département de médecine, Université de Montréal; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | - Emily Bell
- Neuroethics Research Unit; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | | | - Gail Andrew
- Neurodevelopmental/Neuromotor Division, Department of Pediatrics, University of Alberta, Glenrose Rehabilitation Hospital, Edmonton, Alberta
| | - Lorraine E Bell
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec
| | - Margaret Clarke
- Departments of Pediatrics/Psychiatry, Alberta Children's Hospital, Calgary, Alberta
| | - Veljko Dubljevic
- Neuroethics Research Unit; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | - Dan Goldowitz
- NeuroDevNet, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
| | - Annie Janvier
- Division of Neonatology and Clinical Ethics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology, McGill University, Montreal Children's Hospital
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Lisa Anne Rasmussen
- Departments of Pediatrics and Neurology, McGill University, Montreal Children's Hospital, Montreal, Quebec
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | | | - Lucie Wade
- Ethics Program Office, Jewish General Hospital, Montreal, Quebec
| | - Jerome Y Yager
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Rashid M, Goez HR, Mabood N, Damanhoury S, Yager JY, Joyce AS, Newton AS. The impact of pediatric traumatic brain injury (TBI) on family functioning: a systematic review. J Pediatr Rehabil Med 2014; 7:241-54. [PMID: 25260507 DOI: 10.3233/prm-140293] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore the impact moderate to severe traumatic brain injury (TBI) in a child has on family functioning. METHODS The search was conducted using 9 bibliographic databases for articles published between 1980 and 2013. Two reviewers independently screened for inclusion and assessed study quality. Two reviewers extracted study data and a third checked for completeness and accuracy. Findings are presented by three domains: injury-related burden and stress, family adaptability, and family cohesion. RESULTS Nine observational studies were included. Across the studies, differences between study groups for family functioning varied, but there was a trend for more dysfunction in families whose child had a severe TBI as compared to families whose child had a moderate TBI or orthopedic injury. In three studies, injury-associated burden was persistent post-injury and was highest in families whose child had a severe TBI followed by families with a child who had a moderate TBI. One study found fathers reported more family dysfunction caused by their child's injury compared to mothers. Two studies found that mothers' adaptability depended on social support and stress levels while fathers' adaptability was independent of these factors and injury severity. CONCLUSION Moderate to severe TBI has a significant, long-standing impact on family functioning. Factors associated with family adaptability vary by parental role.
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Affiliation(s)
- Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Helly R Goez
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Neelam Mabood
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Samah Damanhoury
- Faculty of Agriculture, Forestry and Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Jerome Y Yager
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Anthony S Joyce
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Yager JY, Shevell M. Prologue. Semin Pediatr Neurol 2013; 20:59. [PMID: 23948679 DOI: 10.1016/j.spen.2013.07.001] [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: 10/26/2022]
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Dowling MM, Hynan LS, Lo W, Licht DJ, McClure C, Yager JY, Dlamini N, Kirkham FJ, Deveber G, Pavlakis S. International Paediatric Stroke Study: stroke associated with cardiac disorders. Int J Stroke 2012; 8 Suppl A100:39-44. [PMID: 23231361 DOI: 10.1111/j.1747-4949.2012.00925.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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: 01/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS The aetiologies of arterial ischaemic stroke in children are diverse and often multifactorial. A large proportion occurs in children with cardiac disorders. We hypothesized that the clinical and radiographic features of children with arterial ischaemic stroke attributed to cardiac disorders would differ from those with other causes. METHODS Using the large population collected in the prospective International Paediatric Stroke Study, we analysed the characteristics, clinical presentations, imaging findings, and early outcomes of children with and without cardiac disorders. RESULTS Aetiological data were available for 667 children with arterial ischaemic stroke (ages 29 days to 19 years). Cardiac disorders were indentified in 204/667 (30.6%), congenital defects in 121/204 (59.3%), acquired in 40/204 (19.6%), and isolated patent foramen ovale in 31/204 (15.2%). Compared to other children with stroke, those with cardiac disorders were younger (median age 3.1 vs. 6.5 years; P < 0.001) and less likely to present with headache (25.6% vs. 44.6%; P < 0.001), but were similar in terms of gender and presentation with focal deficits, seizures, or recent infection. Analysis of imaging data identified significant differences (P = 0.005) in the vascular distribution (anterior vs. posterior circulation or both) between groups. Bilateral strokes and haemorrhagic conversion were more prevalent in the cardiac disorders group. CONCLUSIONS Cardiac disorders were identified in almost one-third of children with arterial ischaemic stroke. They had similar clinical presentations to those without cardiac disorders but differed in age and headache prevalence. Children with cardiac disorders more frequently had a 'cardioembolic stroke pattern' with a higher prevalence of bilateral strokes in both the anterior and posterior circulations, and a greater tendency to haemorrhagic transformation.
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Affiliation(s)
- Michael M Dowling
- The University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, USA
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Jenkins DD, Rollins LG, Perkel JK, Wagner CL, Katikaneni LP, Bass WT, Kaufman DA, Horgan MJ, Languani S, Givelichian L, Sankaran K, Yager JY, Martin RH. Serum cytokines in a clinical trial of hypothermia for neonatal hypoxic-ischemic encephalopathy. J Cereb Blood Flow Metab 2012; 32:1888-96. [PMID: 22805873 PMCID: PMC3463879 DOI: 10.1038/jcbfm.2012.83] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Inflammatory cytokines may mediate hypoxic-ischemic (HI) injury and offer insights into the severity of injury and the timing of recovery. In our randomized, multicenter trial of hypothermia, we analyzed the temporal relationship of serum cytokine levels in neonates with hypoxic-ischemic encephalopathy (HIE) with neurodevelopmental outcome at 12 months. Serum cytokines were measured every 12 hours for 4 days in 28 hypothermic (H) and 22 normothermic (N) neonates with HIE. Monocyte chemotactic protein-1 (MCP-1) and interleukins (IL)-6, IL-8, and IL-10 were significantly higher in the H group. Elevated IL-6 and MCP-1 within 9 hours after birth and low macrophage inflammatory protein 1a (MIP-1a) at 60 to 70 hours of age were associated with death or severely abnormal neurodevelopment at 12 months of age. However, IL-6, IL-8, and MCP-1 showed a biphasic pattern in the H group, with early and delayed peaks. In H neonates with better outcomes, uniform down modulation of IL-6, IL-8, and IL-10 from their peak levels at 24 hours to their nadir at 36 hours was observed. Modulation of serum cytokines after HI injury may be another mechanism of improved outcomes in neonates treated with induced hypothermia.
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Affiliation(s)
- Dorothea D Jenkins
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Kirton A, Armstrong-Wells J, Chang T, Deveber G, Rivkin MJ, Hernandez M, Carpenter J, Yager JY, Lynch JK, Ferriero DM. Symptomatic neonatal arterial ischemic stroke: the International Pediatric Stroke Study. Pediatrics 2011; 128:e1402-10. [PMID: 22123886 DOI: 10.1542/peds.2011-1148] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [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: 11/24/2022] Open
Abstract
BACKGROUND Neonatal arterial ischemic stroke (AIS) has emerged as a leading cause of perinatal brain injury, cerebral palsy, and lifelong disability. The pathogenesis is poorly understood, which limits the development of treatment and prevention strategies. Multicenter studies must define epidemiology, risk factors, treatment practices, and outcomes to advance clinical trials and improve the adverse outcomes suffered by most survivors. METHODS The International Pediatric Stroke Study is a global research initiative of 149 coinvestigators (30 centers in 10 countries). Patients with clinical and neuroimaging confirmation of symptomatic neonatal AIS were enrolled (2003-2007). Standardized, Web-based data entry collected clinical presentations, risk factors, investigations, treatments, and early outcomes. We examined predictors of infarct characteristics and discharge outcome by using multivariate logistic regression. RESULTS Two hundred forty-eight neonates were studied (57% male, 10% premature). Most of them presented with seizure (72%) and nonfocal neurologic signs (63%). MRI was completed for 92% of the infants, although <50% had vascular imaging. Infarcts preferentially involved the anterior circulation and left hemisphere and were multifocal in 30%. Maternal health and pregnancies were usually normal. Neonates often required resuscitation (30%) and had systemic illnesses (23%). Cardiac and prothrombotic abnormalities were identified in <20% of the infants. Antithrombotic treatment was uncommon (21%) and varied internationally. Half (49%) of the infants had deficits at discharge, and data on their long-term outcomes are pending. CONCLUSIONS Newborns with AIS are often systemically sick, whereas their mothers are usually healthy. Definitive causes for most neonatal AISs have not been established, and large-scale case-control studies are required to understand pathogenesis if outcomes are to be improved.
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Affiliation(s)
- Adam Kirton
- Alberta Children's Hospital, Calgary, Alberta, Canada.
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Askalan R, Wang C, Shi H, Armstrong E, Yager JY. The effect of postischemic hypothermia on apoptotic cell death in the neonatal rat brain. Dev Neurosci 2011; 33:320-9. [PMID: 21912083 DOI: 10.1159/000329924] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 06/08/2011] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Hypothermia is the most effective neuroprotective therapy against ischemic injury in the developing brain. However, the mechanism of hypothermic neuroprotection is not well understood. We sought to investigate whether hypothermia mediates neuroprotection by modulating ischemia-induced apoptosis. METHODS Seven-day-old rat pups were randomly assigned to either control or hypoxia-ischemia (HI) groups. In the HI group, the internal carotid artery was ligated and cut. This was followed by transient hypoxia at 8% oxygen for 90 min. In the control rats, the internal carotid was isolated but not ligated. Immediately after the hypoxic episode, pups in the HI group were either placed in water baths maintained at 28°C for 24 h (core temperatures at 31°C) or they remained in a normothermic environment. Animals were sacrificed at 24, 48 and 72 h and 1 week after the HI insult. Brain sections were processed for immunohistochemistry and Western blots. RESULTS Caspase 3 expression was significantly higher in the core compared with the peri-infarct area at all time points in normothermic rats. Hypothermia reduced caspase 3 expression in the core but had little effect in the peri-infarct area. Hypothermia reduced apoptosis-inducing factor translocation to the nucleus in the core and peri-infarct area. Concurrently, X-linked inhibitor of apoptosis (XIAP) expression was significantly potentiated in the hypothermic-ischemic core but not in the peri-infarct area. CONCLUSION Hypothermic modulation of caspase-dependent apoptosis may be mediated by upregulating XIAP. However, the effect of hypothermia on caspase-independent apoptosis may be mediated by XIAP-independent mechanisms. Importantly, these effects are mediated in both the core and the penumbral regions of ischemic lesion.
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Affiliation(s)
- Rand Askalan
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada.
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Goez HR, Jacob FD, Fealey RD, Patterson MC, Ramaswamy V, Persad R, Johnson ES, Yager JY. An unusual presentation of copper metabolism disorder and a possible connection with Niemann-Pick type C. J Child Neurol 2011; 26:518-21. [PMID: 21273508 DOI: 10.1177/0883073810383983] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 11/15/2022]
Abstract
Abnormal copper metabolism has been linked with neurological disorders, such as Wilson and Menkes disease. Another disorder causing symptoms similar to copper metabolism disorder is Niemann-Pick type C. However, a definite pathophysiological connection between Niemann-Pick type C and copper metabolism disorders has never been established. The authors present an adolescent with an unusual presentation of copper deficiency-dysarthria, ataxia, and vertical gaze paresis, without significant cognitive degeneration or pathological magnetic resonance imaging (MRI). The patient was found to carry 2 mutations in the NPC1 gene. A possible link, explaining how copper deficiency might induce the Niemann-Pick phenotype might involve overproduction of cholesterol and inhibition of acid sphingomyelinase. We suggest that copper metabolism disorders be included in the differential diagnosis for ataxia and dysarthria, even in cases with unusual presentations. Moreover, should the connection between copper and Niemann-Pick be validated, screening for copper metabolism disorders may be advisable in Niemann-Pick type C patients and vice-versa.
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Affiliation(s)
- Helly R Goez
- Stollery Children’s Hospital in Edmonton, Alberta, Canada.
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Abstract
Copper is a trace element that is required for cellular respiration, neurotransmitter biosynthesis, pigment formation, antioxidant defense, peptide amidation, and formation of connective tissue. Abnormalities of copper metabolism have been linked with neurologic disorders that affect movement, such as Wilson disease and Menkes disease; however, the diagnosis of non-Wilson, non-Menkes-type copper-metabolism disorders has been more elusive, especially in cases with atypical characteristics. We present here the case of an adolescent with a novel presentation of copper-metabolism disorder who exhibited acute severe hemilingual dyskinesia and prominent tics, with ballismus of the upper limbs, but had normal brain and spinal MRI results and did not show any signs of dysarthria or dysphagia. His serum copper and ceruloplasmin levels were low, but his urinary copper level was elevated after penicillamine challenge. We conclude that copper-metabolism disorders should be included in the differential diagnosis for movement disorders, even in cases with highly unusual presentations, because many of them are treatable. Moreover, a connection between copper-metabolism disorders and tics is presented, to our knowledge, for the first time in humans; further investigation is needed to better establish this connection and understand its underlying pathophysiology.
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Affiliation(s)
- Helly R Goez
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada.
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Saucier DM, Yager JY, Armstrong EA. Housing environment and sex affect behavioral recovery from ischemic brain damage. Behav Brain Res 2010; 214:48-54. [PMID: 20434487 DOI: 10.1016/j.bbr.2010.04.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/21/2010] [Accepted: 04/22/2010] [Indexed: 10/19/2022]
Abstract
In previous work from our laboratory, we have developed a model of stroke that allows the comparison of stroke injury across age groups (10-day old, 63-day old, 180-day old rats). In this current study, we incorporated environmental enrichment to determine whether this form of rehabilitation alters behavioral recovery, and whether age and/or sex interacts with enrichment. Our results indicated that ischemic male rats that were housed in standard cages (shoebox housed) performed the poorest on two tasks of motor ability, and that this performance was related to the size of the lesion. With the exception of lesion size, in which 10-day old enriched rats had significantly smaller lesions than either the enriched 63-day old rats or the 180-day old rats, we observed no significant effects of age on behavioral recovery. Thus, our results are consistent with the observation that male rats may be more vulnerable to stroke and that they may differentially benefit from enrichment.
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Affiliation(s)
- Deborah M Saucier
- Department of Neuroscience, University of Lethbridge, Lethbridge, Canada, T1K 3M4.
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Hartfield DS, Tan J, Yager JY, Rosychuk RJ, Spady D, Haines C, Craig WR. The association between iron deficiency and febrile seizures in childhood. Clin Pediatr (Phila) 2009; 48:420-6. [PMID: 19229063 DOI: 10.1177/0009922809331800] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [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: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to determine the association between iron deficiency and febrile seizures in a large cohort of children aged 6 to 36 months. METHODS A retrospective case control study with 361 patients who presented with febrile seizures to the emergency department and 390 otherwise healthy controls who presented with a febrile illness to the emergency department were reviewed to determine iron status using the MCV, RDW, and hemoglobin. RESULTS A total of 9% of cases had iron deficiency (ID) and 6% had iron deficiency anemia (IDA), compared to 5% and 4% of controls respectively. The conditional logistic regression odds ratio for ID in patients with febrile seizures was 1.84 (95% CI, 1.02-3.31). CONCLUSION Children with febrile seizures were almost twice as likely to be iron deficient as those with febrile illness alone. The results suggest that screening for ID should be considered in children presenting with febrile seizure.
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Affiliation(s)
- Dawn S Hartfield
- Department of Pediatrics, University of Alberta, Edmonton, Canada.
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Massicotte MP, Yager JY. Stroke in children: first steps on the road to intervention. Circulation 2009; 119:1361-2. [PMID: 19255339 DOI: 10.1161/circulationaha.108.829069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Jerome Y Yager
- Section of Pediatric Neurosciences, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Yager JY, Armstrong EA, Black AM. Treatment of the term newborn with brain injury: simplicity as the mother of invention. Pediatr Neurol 2009; 40:237-43. [PMID: 19218037 DOI: 10.1016/j.pediatrneurol.2008.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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: 10/27/2008] [Accepted: 11/03/2008] [Indexed: 11/28/2022]
Abstract
Neonatal brain injury remains a common cause of developmental disability, despite tremendously enhanced obstetrical and neonatal care. The timing of brain injury occurs throughout gestation, labor, and delivery, providing an evolving form of brain injury and a moving target for therapeutic intervention. Nonetheless, markedly improved methods are available to identify those infants injured at birth, via clinical presentation with neonatal encephalopathy and neuroimaging techniques. Postischemic hypothermia has been shown to be of tremendous clinical promise in several completed and ongoing trials. As part of this approach to the treatment of the newborn, other parameters of physiologic homeostasis can and should be attended to, with strong animal and clinical evidence that their correction will have dramatic influence on the outcome of the newborn infant. This review addresses aspects of newborn care to which we can direct our attention currently, and which should result in a safe and efficacious improvement in the prognosis of the newborn with neonatal encephalopathy.
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Affiliation(s)
- Jerome Y Yager
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Ramaswamy V, Mehta V, Bauman M, Richer L, Massicotte P, Yager JY. Decompressive hemicraniectomy in children with severe ischemic stroke and life-threatening cerebral edema. J Child Neurol 2008; 23:889-94. [PMID: 18403586 DOI: 10.1177/0883073808314960] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [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: 11/16/2022]
Abstract
Decompressive hemicraniectomy has been discussed as a treatment option that increases survival in adults with malignant stroke. This approach has not been studied extensively in children. From a prospective cohort, we identified 4 children who underwent decompressive hemicraniectomy for malignant infarctions with life-threatening cerebral edema within 72 hours of their stroke. All 4 children had different causes for their stroke and experienced severe cerebral edema with increasing intracranial pressure and an impending fatal outcome. Despite massive cerebral infarction, all patients were ambulant and able to speak at the time of follow-up. Although a limited experience, decompressive hemicraniectomy is a life-saving approach for malignant stroke in children.
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Affiliation(s)
- Vijay Ramaswamy
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Black AM, Pandya S, Clark D, Armstrong EA, Yager JY. Effect of caffeine and morphine on the developing pre-mature brain. Brain Res 2008; 1219:136-42. [DOI: 10.1016/j.brainres.2008.04.066] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 04/13/2008] [Accepted: 04/17/2008] [Indexed: 11/16/2022]
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Abstract
We describe a case of concomitant Graves' disease and demyelination, with optic neuritis and cerebellar dysfunction, in an adolescent girl. Autoimmune thyroid disease with encephalopathy is the hallmark of Hashimoto's encephalopathy, linking thyroid and central nervous system dysfunction. However, to our knowledge, Graves' disease has not been previously reported in association with clinically isolated demyelinating disease in childhood.
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Affiliation(s)
- Rebecca S Mitchell
- Department of Medicine, Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Canada.
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Saucier DM, Yager JY, Armstrong EA, Keller A, Shultz S. Enriched environment and the effect of age on ischemic brain damage. Brain Res 2007; 1170:31-8. [PMID: 17714698 DOI: 10.1016/j.brainres.2007.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 07/09/2007] [Accepted: 07/12/2007] [Indexed: 11/24/2022]
Abstract
Stroke affects all age groups from the newborn to the elderly. Previous work from our laboratory has shown that despite a greater susceptibility to brain damage, the immature brain recovers more rapidly and to a greater extent than does the more mature nervous system. In the current study, we examined the influence of environmental enrichment on the effects of age on the brain damaging effects of stroke. Rats aged 10, 63, and 180 days received ischemic insults following stereotactic intra-cerebral injection of endothelin-1, and resulting in injury to the right middle cerebral artery territory. Rats were then housed in either environmentally enriched cages, or standard cages for 60 days, after which they were sacrificed, and brain volumes determined for the extent of neurologic injury. Rats receiving the insult at 10 days of age showed a reduction of pathologic injury when housed in the enriched cages compared to standard. Conversely, rats receiving the insult at 180 days and housed environmentally enriched cages actually showed an increased volume of brain damage compared to controls. Our findings clearly indicate the dramatic influence of age on the extent of stroke and the influence of rehabilitative therapies. Behavioral correlation to morphologic alterations is required. Attempts at therapeutic interventions clearly need to be age-specific.
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Affiliation(s)
- Deborah M Saucier
- Department of Neuroscience, 4401 University Dr., University of Lethbridge, Lethbridge, Alberta, Canada.
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Yager JY, Wright S, Armstrong EA, Jahraus CM, Saucier DM. The influence of aging on recovery following ischemic brain damage. Behav Brain Res 2006; 173:171-80. [PMID: 16899307 DOI: 10.1016/j.bbr.2006.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Revised: 06/08/2006] [Accepted: 06/08/2006] [Indexed: 11/19/2022]
Abstract
Stroke is a health hazard that affects all age groups, however the impact of age on brain injury following ischemia remains largely unexamined. We examined the extent to which age, from the newborn to mature adult, affects behavioral recovery following similar degrees of ischemic brain damage. We utilized a model that produces comparable volumes of brain damage between the different ages. Endothelin-1, a potent vasoconstrictor, was injected into the brain of 10, 63 and 180-day-old rats, at the level of the right middle cerebral artery. On days 3, 7, 14, 28 and 56 post-insult, behavioral tests including rota-rod, foot-fault, open-field, inclined screen, tape-removal test and postural reflex were performed. Control animals underwent sham surgery, but ischemia was not induced. Neuropathology was assessed on day 63 post-insult. Volume of damage was determined for each brain as a percentage of the contralateral hemisphere (which remains undamaged). Our results indicated that the volume of damage for each age group was 22.97, 19.97, and 18.85% for 10, 63 and 180-day-old rats, respectively, and were not significantly different from each other. Overall, ischemic animals did significantly more poorly on behavioral testing than did controls. When broken down by age, the difference between ischemics and controls was only evident in the 63 and 180-day-old animals. The tape-removal test revealed main effects of age, group, and day (p<0.001). In addition, significant interactions were noted for day of testing by age (p<0.001), day of testing by group with ischemics performing more slowly than controls, and an age by group interaction which indicated that the 63 and 180-day-old ischemic rats did not recover completely during the testing period and remained significantly slower than their controls (p<0.001). In the foot-fault task, the 63 and 180-day-old ischemic animals performed significantly more poorly on days 3, 7, and 14 of recovery, returning to control values by day 28. The 180-day olds performed more poorly on day 3 of recovery, but then returned to control values. For open-field testing, the results indicate an overall difference between ischemics and controls, with the 63 and 180-day-old animals improving with time though they did not achieve control values. In conclusion our data suggest functional performance is poorly and inconsistently correlated with the extent of morphologic injury across all age groups. The immature rat clearly recovers more completely and more rapidly than do older, more mature rats. The findings may imply a greater degree of brain plasticity in the infant rat compared to the adult, and have important implications related to the underlying mechanisms of recovery and the association between brain damage and functional improvement.
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