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Huang SY, Salomon M, Eikermann-Haerter K. Advanced brain MRI may help understand the link between migraine and multiple sclerosis. J Headache Pain 2023; 24:113. [PMID: 37596546 PMCID: PMC10439604 DOI: 10.1186/s10194-023-01645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a clinical association between migraine and multiple sclerosis. MAIN BODY Migraine and MS patients share similar demographics, with the highest incidence among young, female and otherwise healthy patients. The same hormonal constellations/changes trigger disease exacerbation in both entities. Migraine prevalence is increased in MS patients, which is further enhanced by disease-modifying treatment. Clinical data show that onset of migraine typically starts years before the clinical diagnosis of MS, suggesting that there is either a unidirectional relationship with migraine predisposing to MS, and/or a "shared factor" underlying both conditions. Brain imaging studies show white matter lesions in both MS and migraine patients. Neuroinflammatory mechanisms likely play a key role, at least as a shared downstream pathway. In this review article, we provide an overview of the literature about 1) the clinical association between migraine and MS as well as 2) brain MRI studies that help us better understand the mechanistic relationship between both diseases with implications on their underlying pathophysiology. CONCLUSION Studies suggest a migraine history predisposes patients to develop MS. Advanced brain MR imaging may shed light on shared and distinct features, while helping us better understand mechanisms underlying both disease entities.
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Affiliation(s)
- Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marc Salomon
- Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY, 10016, USA
| | - Katharina Eikermann-Haerter
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY, 10016, USA.
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2
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Oka F, Lee JH, Yuzawa I, Li M, von Bornstaedt D, Eikermann-Haerter K, Qin T, Chung DY, Sadeghian H, Seidel JL, Imai T, Vuralli D, Platt RF, Nelson MT, Joutel A, Sakadzic S, Ayata C. CADASIL mutations sensitize the brain to ischemia via spreading depolarizations and abnormal extracellular potassium homeostasis. J Clin Invest 2022; 132:149759. [PMID: 35202003 PMCID: PMC9012276 DOI: 10.1172/jci149759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy, subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of small vessel disease characterized by migraine with aura, leukoaraiosis, strokes and dementia. CADASIL mutations cause cerebrovascular dysfunction in both animal models and humans. Here, we show that two different human CADASIL mutations (Notch3 R90C or R169C) worsen ischemic stroke outcomes in transgenic mice, explained by a higher blood flow threshold to maintain tissue viability. Both mutants developed larger infarcts and worse neurological deficits compared with wild type regardless of age or sex after filament middle cerebral artery occlusion. However, full-field laser speckle flowmetry during distal middle cerebral artery occlusion showed comparable perfusion deficits in mutants and their respective wild type controls. Circle of Willis anatomy and pial collateralization also did not differ among the genotypes. In contrast, mutants had a higher cerebral blood flow threshold below which infarction ensued, suggesting increased sensitivity of brain tissue to ischemia. Electrophysiological recordings revealed a 1.5- to 2-fold higher frequency of peri-infarct spreading depolarizations in CADASIL mutants. Higher extracellular K+ elevations during spreading depolarizations in the mutants implicated a defect in extracellular K+ clearance. Altogether, these data reveal a novel mechanism of enhanced vulnerability to ischemic injury linked to abnormal extracellular ion homeostasis and susceptibility to ischemic depolarizations in CADASIL.
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Affiliation(s)
- Fumiaki Oka
- Department of Neurosurgery, Yamaguchi Graduate School of Medicine, Ube, Japan
| | - Jeong Hyun Lee
- Therapeutics & Biotechnology Division, Korea Research Institute of Chemical Technology, Daejeon, Korea, Democratic Peoples Republic of
| | - Izumi Yuzawa
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Mei Li
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Daniel von Bornstaedt
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Katharina Eikermann-Haerter
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Tao Qin
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - David Y Chung
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Homa Sadeghian
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Jessica L Seidel
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Takahiko Imai
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Doga Vuralli
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Rosangela Fm Platt
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
| | - Mark T Nelson
- Department of Pharmacology, University of Vermont, Burlington, United States of America
| | - Anne Joutel
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université de Paris, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Sava Sakadzic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, United States of America
| | - Cenk Ayata
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Charlestown, United States of America
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Abstract
In this issue of Neuron, Parker et al. discover neuronal plumes of glutamate release that initiate spreading depolarization, the electrophysiologic event underlying migraine. Mice with human migraine mutations express spontaneous and frequent plumes, which may explain the propensity to develop migraine attacks and the increased stroke risk in migraine-susceptible brains.
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4
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Eikermann-Haerter K, Huang SY. White Matter Lesions in Migraine. Am J Pathol 2021; 191:1955-1962. [PMID: 33636178 DOI: 10.1016/j.ajpath.2021.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 12/20/2022]
Abstract
Migraine, the third most common disease worldwide, is a well-known independent risk factor for subclinical focal deep white matter lesions (WMLs), even in young and otherwise healthy individuals with no cardiovascular risk factors. These WMLs are more commonly seen in migraine patients with transient neurologic symptoms preceding their headaches, the so-called aura, and those with a high attack frequency. The pathophysiology of migraine-related deep white matter hyperintensities remains poorly understood despite their prevalence. Characteristic differences in their distribution related to chronic small vessel ischemic disease compared with that of common periventricular WMLs in the elderly suggest a different underlying mechanism. Both ischemic and inflammatory mechanisms have been proposed, as there is increased cerebral vulnerability to ischemia in migraineurs, whereas there is also evidence of blood-brain barrier disruption with associated release of proinflammatory substances during migraine attacks. An enhanced susceptibility to spreading depolarization, the electrophysiological event underlying migraine, may be the mechanism that causes repetitive episodes of cerebral hypoperfusion and neuroinflammation during migraine attacks. WMLs can negatively affect both physical and cognitive function, underscoring the public health importance of migraine, and suggesting that migraine is an important contributor to neurologic deficits in the general population.
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Affiliation(s)
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
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5
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Rapalino O, Weerasekera A, Moum SJ, Eikermann-Haerter K, Edlow BL, Fischer D, Torrado-Carvajal A, Loggia ML, Mukerji SS, Schaefer PW, Gonzalez RG, Lev MH, Ratai EM. Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations. AJNR Am J Neuroradiol 2021; 42:37-41. [PMID: 33122208 PMCID: PMC7814804 DOI: 10.3174/ajnr.a6877] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/13/2020] [Indexed: 11/07/2022]
Abstract
Brain multivoxel MR spectroscopic imaging was performed in 3 consecutive patients with coronavirus disease 2019 (COVID-19). These included 1 patient with COVID-19-associated necrotizing leukoencephalopathy, another patient who had a recent pulseless electrical activity cardiac arrest with subtle white matter changes, and a patient without frank encephalopathy or a recent severe hypoxic episode. The MR spectroscopic imaging findings were compared with those of 2 patients with white matter pathology not related to Severe Acute Respiratory Syndrome coronavirus 2 infection and a healthy control subject. The NAA reduction, choline elevation, and glutamate/glutamine elevation found in the patient with COVID-19-associated necrotizing leukoencephalopathy and, to a lesser degree, the patient with COVID-19 postcardiac arrest, follow a similar pattern as seen with the patient with delayed posthypoxic leukoencephalopathy. Lactate elevation was most pronounced in the patient with COVID-19 necrotizing leukoencephalopathy.
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Affiliation(s)
- O Rapalino
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
| | - A Weerasekera
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
- A.A. Martinos Center for Biomedical Imaging (A.W., A.T.-C., M.L.L., E.R.), Charlestown, Massachusetts
| | - S J Moum
- Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine (S.J.M.)
| | - K Eikermann-Haerter
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
| | - B L Edlow
- Neurology (B.L.E., D.F., S.S.M.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - D Fischer
- Neurology (B.L.E., D.F., S.S.M.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - A Torrado-Carvajal
- A.A. Martinos Center for Biomedical Imaging (A.W., A.T.-C., M.L.L., E.R.), Charlestown, Massachusetts
- Medical Image Analysis and Biometry Laboratory (A.T.-C.), Universidad Rey Juan Carlos, Madrid, Spain
| | - M L Loggia
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
- A.A. Martinos Center for Biomedical Imaging (A.W., A.T.-C., M.L.L., E.R.), Charlestown, Massachusetts
| | - S S Mukerji
- Neurology (B.L.E., D.F., S.S.M.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - P W Schaefer
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
| | - R G Gonzalez
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
| | - M H Lev
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
| | - E-M Ratai
- From the Departments of Radiology (O.R., A.W., K.E.-H., M.L.L., P.W.S., R.G.G., M.H.L., E.R.)
- A.A. Martinos Center for Biomedical Imaging (A.W., A.T.-C., M.L.L., E.R.), Charlestown, Massachusetts
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6
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Negro A, Seidel JL, Houben T, Yu ES, Rosen I, Arreguin AJ, Yalcin N, Shorser-Gentile L, Pearlman L, Sadhegian H, Vetrivelan R, Chamberlin NL, Ayata C, Martelletti P, Moskowitz MA, Eikermann-Haerter K. Acute sleep deprivation enhances susceptibility to the migraine substrate cortical spreading depolarization. J Headache Pain 2020; 21:86. [PMID: 32631251 PMCID: PMC7339460 DOI: 10.1186/s10194-020-01155-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Migraine is a common headache disorder, with cortical spreading depolarization (CSD) considered as the underlying electrophysiological event. CSD is a slowly propagating wave of neuronal and glial depolarization. Sleep disorders are well known risk factors for migraine chronification, and changes in wake-sleep pattern such as sleep deprivation are common migraine triggers. The underlying mechanisms are unknown. As a step towards developing an animal model to study this, we test whether sleep deprivation, a modifiable migraine trigger, enhances CSD susceptibility in rodent models. METHODS Acute sleep deprivation was achieved using the "gentle handling method", chosen to minimize stress and avoid confounding bias. Sleep deprivation was started with onset of light (diurnal lighting conditions), and assessment of CSD was performed at the end of a 6 h or 12 h sleep deprivation period. The effect of chronic sleep deprivation on CSD was assessed 6 weeks or 12 weeks after lesioning of the hypothalamic ventrolateral preoptic nucleus. All experiments were done in a blinded fashion with respect to sleep status. During 60 min of continuous topical KCl application, we assessed the total number of CSDs, the direct current shift amplitude and duration of the first CSD, the average and cumulative duration of all CSDs, propagation speed, and electrical CSD threshold. RESULTS Acute sleep deprivation of 6 h (n = 17) or 12 h (n = 11) duration significantly increased CSD frequency compared to controls (17 ± 4 and 18 ± 2, respectively, vs. 14 ± 2 CSDs/hour in controls; p = 0.003 for both), whereas other electrophysiological properties of CSD were unchanged. Acute total sleep deprivation over 12 h but not over 6 h reduced the electrical threshold of CSD compared to controls (p = 0.037 and p = 0.095, respectively). Chronic partial sleep deprivation in contrast did not affect CSD susceptibility in rats. CONCLUSIONS Acute but not chronic sleep deprivation enhances CSD susceptibility in rodents, possibly underlying its negative impact as a migraine trigger and exacerbating factor. Our findings underscore the importance of CSD as a therapeutic target in migraine and suggest that headache management should identify and treat associated sleep disorders.
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Affiliation(s)
- Andrea Negro
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Jessica L Seidel
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Thijs Houben
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Esther S Yu
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Ike Rosen
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Andrea J Arreguin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nilufer Yalcin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Lea Shorser-Gentile
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Lea Pearlman
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Homa Sadhegian
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Ramalingam Vetrivelan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michael A Moskowitz
- Department of Radiology, and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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7
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Sprouse Blum AS, Lavoie B, Haag M, Mawe SM, Tolner EA, van den Maagdenberg AMJM, Chen SP, Eikermann-Haerter K, Ptáček L, Mawe GM, Shapiro RE. No Gastrointestinal Dysmotility in Transgenic Mouse Models of Migraine. Headache 2019; 60:396-404. [PMID: 31876298 DOI: 10.1111/head.13724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether transgenic mouse models of migraine exhibit upper gastrointestinal dysmotility comparable to those observed in migraine patients. BACKGROUND There is considerable evidence supporting the comorbidity of gastrointestinal dysmotility and migraine. Gastrointestinal motility, however, has never been investigated in transgenic mouse models of migraine. METHODS Three transgenic mouse strains that express pathogenic gene mutations linked to monogenic migraine-relevant phenotypes were studied: CADASIL (Notch3-Tg88), FASP (CSNK1D-T44A), and FHM1 (CACNA1A-S218L). Upper gastrointestinal motility was quantified by measuring gastric emptying and small intestinal transit in mutant and control animals. Gastrointestinal motility was measured at baseline and after pretreatment with 10 mg/kg nitroglycerin (NTG). RESULTS No significant differences were observed for gastric emptying or small intestinal transit at baseline for any of the 3 transgenic strains when compared to appropriate controls or after pretreatment with NTG when compared to vehicle. CONCLUSIONS We detected no evidence of upper gastrointestinal dysmotility in mice that express mutations in genes linked to monogenic migraine-relevant phenotypes. Future studies seeking to understand why humans with migraine experience delayed gastric emptying may benefit from pursuing other modifiers of gastrointestinal motility, such as epigenetic or microbiome-related factors.
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Affiliation(s)
- Adam S Sprouse Blum
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - Brigitte Lavoie
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - Melody Haag
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - Seamus M Mawe
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - Else A Tolner
- Departments of Human Genetics & Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Shih-Pin Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Louis Ptáček
- Department of Neurology, Weill Neuroscience Institute, and Kavli Institute for Fundamental Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Gary M Mawe
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
| | - Robert E Shapiro
- Department of Neurological Sciences, The University of Vermont, Burlington, VT, USA
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8
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Balkaya M, Seidel JL, Sadeghian H, Qin T, Chung DY, Eikermann-Haerter K, van den Maagdenberg AMJM, Ferrari MD, Ayata C. Relief Following Chronic Stress Augments Spreading Depolarization Susceptibility in Familial Hemiplegic Migraine Mice. Neuroscience 2019; 415:1-9. [PMID: 31299346 DOI: 10.1016/j.neuroscience.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/06/2018] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
Cortical spreading depolarization (CSD) is the electrophysiological substrate of migraine aura, and a putative trigger of trigeminovascular activation and migraine headache. Many migraineurs report stress or relief after a stress triggers an attack. We tested whether various stress conditions might modulate CSD susceptibility and whether this is dependent on genetic factors. Male and female wild type and familial hemiplegic migraine type1 (FHM1) knock-in mice heterozygous for the S218L missense mutation were subjected to acute or chronic stress, or chronic stress followed by relief (36 h). Acute stress was induced by restraint and exposure to bright light and white noise (3 h). Chronic stress was induced for 28 days by two cycles of repeated exposure of mice to a rat (7 days), physical restraint (3 days), and forced swimming (3 days). Electrical CSD threshold and KCl-induced (300 mM) CSD frequency were determined in occipital cortex in vivo at the end of each protocol. Relief after chronic stress reduced the electrical CSD threshold and increased the frequency of KCl-induced CSDs in FHM1 mutants only. Acute or chronic stress without relief did not affect CSD susceptibility in either strain. Stress status did not affect CSD propagation speed, duration or amplitude. In summary, relief after chronic stress, but not acute or chronic stress alone, augments CSD in genetically susceptible mice. Therefore, enhanced CSD susceptibility may explain why, in certain patients, migraine attacks typically occur during a period of stress relief such as weekends or holidays.
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Affiliation(s)
- Mustafa Balkaya
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jessica L Seidel
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Homa Sadeghian
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Tao Qin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - David Y Chung
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Arn M J M van den Maagdenberg
- Department of Neurology Leiden University Medical Center, Leiden 2300, RC, the Netherlands; Human Genetics, Leiden University Medical Center, Leiden 2300, RC, the Netherlands
| | - Michel D Ferrari
- Department of Neurology Leiden University Medical Center, Leiden 2300, RC, the Netherlands
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA.
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9
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Abstract
BACKGROUND Population-based studies have highlighted a close relationship between migraine and stroke. Migraine, especially with aura, is a risk factor for both ischemic and hemorrhagic stroke. Interestingly, stroke risk is highest for migraineurs who are young and otherwise healthy. MAIN BODY Preclinical models have provided us with possible mechanisms to explain the increased vulnerability of migraineurs' brains towards ischemia and suggest a key role for enhanced cerebral excitability and increased incidence of microembolic events. Spreading depolarization (SD), a slowly propagating wave of neuronal depolarization, is the electrophysiologic event underlying migraine aura and a known headache trigger. Increased SD susceptibility has been demonstrated in migraine animal models, including transgenic mice carrying human mutations for the migraine-associated syndrome CADASIL and familial hemiplegic migraine (type 1 and 2). Upon experimentally induced SD, these mice develop aura-like neurological symptoms, akin to patients with the respective mutations. Migraine mutant mice also exhibit an increased frequency of ischemia-triggered SDs upon experimental stroke, associated with accelerated infarct growth and worse outcomes. The severe stroke phenotype can be explained by SD-related downstream events that exacerbate the metabolic mismatch, including pericyte contraction and neuroglial inflammation. Pharmacological suppression of the genetically enhanced SD susceptibility normalizes the stroke phenotype in familial hemiplegic migraine mutant mice. Recent epidemiologic and imaging studies suggest that these preclinical findings can be extrapolated to migraine patients. Migraine patients are at risk for particularly cardioembolic stroke. At the same time, studies suggest an increased incidence of coagulopathy, atrial fibrillation and patent foramen ovale among migraineurs, providing a possible path for microembolic induction of SD and, in rare instances, stroke in hyperexcitable brains. Indeed, recent imaging studies document an accelerated infarct progression with only little potentially salvageable brain tissue in acute stroke patients with a migraine history, suggesting an increased vulnerability towards cerebral ischemia. CONCLUSION Preclinical models suggest a key role for enhanced SD susceptibility and microembolization to explain both the occurrence of migraine attacks and the increased stroke risk in migraineurs. Therapeutic targeting of SD and microembolic events, or potential causes thereof, will be promising for treatment of aura and may also prevent ischemic infarction in vulnerable brains.
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Affiliation(s)
- Muge Yemisci
- Institute of Neurological Sciences and Psychiatry, and Faculty of Medicine, Department of Neurology, Hacettepe University, Ankara, Turkey
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10
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Yalcin N, Chen SP, Yu ES, Liu TT, Yen JC, Atalay YB, Qin T, Celik F, van den Maagdenberg AM, Moskowitz MA, Ayata C, Eikermann-Haerter K. Caffeine does not affect susceptibility to cortical spreading depolarization in mice. J Cereb Blood Flow Metab 2019; 39:740-750. [PMID: 29651899 PMCID: PMC6446422 DOI: 10.1177/0271678x18768955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/03/2023]
Abstract
Several factors that modulate migraine, a common primary headache disorder, also affect susceptibility to cortical spreading depolarization (CSD). CSD is a wave of neuronal and glial depolarization and thought to underlie the migraine aura and possibly headache. Here, we tested whether caffeine, known to alleviate or trigger headache after acute exposure or chronic use/withdrawal, respectively, modulates CSD. We injected C57BL/6J mice with caffeine (30, 60, or 120 mg/kg; i.p.) once ( acute) or twice per day for one or two weeks ( chronic). Susceptibility to CSD was evaluated by measuring the electrical CSD threshold and by assessing KCl-induced CSD. Simultaneous laser Doppler flowmetry was used to assess CSD-induced cortical blood flow changes. Recordings were performed 15 min after caffeine/vehicle administration, or 24 h after the last dose of chronic caffeine in the withdrawal group. The latter paradigm was also tested in mice carrying the familial hemiplegic migraine type 1 R192Q missense mutation, considered a valid migraine model. Neither acute/chronic administration nor withdrawal of caffeine affected CSD susceptibility or related cortical blood flow changes, either in WT or R192Q mice. Hence, adverse or beneficial effects of caffeine on headache seem unrelated to CSD pathophysiology, consistent with the non-migrainous clinical presentation of caffeine-related headache.
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Affiliation(s)
- Nilufer Yalcin
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Shih-Pin Chen
- 2 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,3 Department of Medical Research, Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan.,4 Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Esther S Yu
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Tzu-Ting Liu
- 5 Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Jiin-Cherng Yen
- 5 Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Yahya B Atalay
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Tao Qin
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Furkan Celik
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Arn Mjm van den Maagdenberg
- 6 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,7 Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael A Moskowitz
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Cenk Ayata
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA.,8 Department of Neurology, Harvard Medical School, Stroke Service and Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Katharina Eikermann-Haerter
- 1 Neurovascular Research Laboratory, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
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11
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Abstract
Objective To review and discuss the literature on the role of cortical structure and function in migraine. Discussion Structural and functional findings suggest that changes in cortical morphology and function contribute to migraine susceptibility by modulating dynamic interactions across cortical and subcortical networks. The involvement of the cortex in migraine is well established for the aura phase with the underlying phenomenon of cortical spreading depolarization, while increasing evidence suggests an important role for the cortex in perception of head pain and associated sensations. As part of trigeminovascular pain and sensory processing networks, cortical dysfunction is likely to also affect initiation of attacks. Conclusion Morphological and functional changes identified across cortical regions are likely to contribute to initiation, cyclic recurrence and chronification of migraine. Future studies are needed to address underlying mechanisms, including interactions between cortical and subcortical regions and effects of internal (e.g. genetics, gender) and external (e.g. sensory inputs, stress) modifying factors, as well as possible clinical and therapeutic implications.
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Affiliation(s)
- Else A Tolner
- Departments of Neurology and Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
- Else A Tolner, Departments of Neurology & Human Genetics, Leiden University Medical Center, Postzone S4-P, PO Box 9600, Leiden, The Netherlands.
| | - Shih-Pin Chen
- Insitute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei
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12
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Platzbecker K, Zhang MB, Kurth T, Rudolph MI, Eikermann-Haerter K, Burstein R, Eikermann M, Houle T. The association between migraine and hospital readmission due to pain after surgery: A hospital registry study. Cephalalgia 2019; 39:286-295. [PMID: 29984600 PMCID: PMC7192134 DOI: 10.1177/0333102418786457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Migraine has been identified as a risk factor of 30-day hospital readmission after surgery. We aimed to further characterize this association examining pain as a potentially migraine-associated, preventable reason for readmission. HYPOTHESIS Compared to patients with no migraine, surgical patients with migraine are at increased risk of 30-day hospital readmission with an admitting diagnosis specifying pain. METHODS This hospital registry study examined 150,710 patients aged 18 years and above, who underwent surgery with general anesthesia and mechanical ventilation between 2007 and 2015 at a tertiary care center and two affiliated community hospitals in Massachusetts, USA. RESULTS Migraine was associated with an increased risk of 30-day pain-related readmission after surgery (adjusted odds ratio 1.42 [95% confidence interval 1.15-1.75]). The association was stronger for migraine with aura (compared to migraine without aura: Adjusted odds ratio 1.69 [95% confidence interval 1.06-2.70]; compared to no migraine: Adjusted odds ratio 2.20 [95% confidence interval 1.44-3.37]). The predicted adjusted risk of pain-related 30-day readmissions was 9.1 [95% confidence interval 5.3-13.0] in 1000 surgical patients with migraine with aura and 5.4 [95% confidence interval 4.2-6.6] in 1000 patients with migraine without aura, compared to 4.2 [95% confidence interval 3.8-4.5] in 1000 patients with no migraine. Furthermore, migraine was associated with an increased risk of postsurgical 30-day readmission due to a priori defined migraine-related pain (headache or abdominal pain) (adjusted odds ratio 1.55 [95% confidence interval 1.20-2.00]). CONCLUSION Patients with migraine undergoing surgery are at increased risk of 30-day hospital readmission due to pain.
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Affiliation(s)
- Katharina Platzbecker
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Megan Behua Zhang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maira Isabella Rudolph
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
| | - Timothy Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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13
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Schroeder RA, Brandes J, Buse DC, Calhoun A, Eikermann-Haerter K, Golden K, Halker R, Kempner J, Maleki N, Moriarty M, Pavlovic J, Shapiro RE, Starling A, Young WB, Nebel RA. Sex and Gender Differences in Migraine—Evaluating Knowledge Gaps. J Womens Health (Larchmt) 2018; 27:965-973. [DOI: 10.1089/jwh.2018.7274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Jan Brandes
- Nashville Neuroscience Group, Nashville, Tennessee
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | - Dawn C. Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Anne Calhoun
- Carolina Headache Institute, Durham, North Carolina
| | | | | | - Rashmi Halker
- Department of Neurology, Mayo Clinic, Phoenix, Arizona
| | - Joanna Kempner
- Department of Sociology, Rutgers University, New Brunswick, New Jersey
| | - Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Maureen Moriarty
- Department of Nursing, Marymount University, Arlington, Virginia
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Robert E. Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | | | - William B. Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca A. Nebel
- Society for Women's Health Research, Washington, District of Columbia
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14
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Ferrari EJ, Crotty RK, Eikermann-Haerter K, Stone JR. Hereditary multiple exostoses as a novel cause of bilateral popliteal artery aneurysms in the elderly. Cardiovasc Pathol 2017; 31:20-25. [PMID: 28818770 DOI: 10.1016/j.carpath.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/28/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022] Open
Abstract
Hereditary multiple exostoses (HME) is a genetic condition characterized by the development of multiple osteochondromas during childhood and adolescence. On rare occasions, these bony tumors can be associated with vascular injury, most commonly involving the popliteal artery. Such patients typically present with vascular complications in adolescence and young adulthood. We report an autopsy study of an elderly man who presented with bilateral popliteal artery pseudoaneurysms in the setting of HME at age 81. This is the oldest patient presenting with a vascular complication due to HME reported to date, as well as the only known case of bilateral popliteal pseudoaneurysms caused by HME. This is also the only autopsy study of this vascular complication so far reported. Our case illustrates that vascular complications from HME can occur even in the elderly, and may show bilateral involvement.
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Affiliation(s)
- Eliza J Ferrari
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rory K Crotty
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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15
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Chen SP, Qin T, Seidel JL, Zheng Y, Eikermann M, Ferrari MD, van den Maagdenberg AMJM, Moskowitz MA, Ayata C, Eikermann-Haerter K. Inhibition of the P2X7-PANX1 complex suppresses spreading depolarization and neuroinflammation. Brain 2017; 140:1643-1656. [PMID: 28430869 DOI: 10.1093/brain/awx085] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 02/12/2017] [Indexed: 01/09/2023] Open
Abstract
Spreading depolarization is a wave of neuronal and glial depolarization. Within minutes after spreading depolarization, the neuronal hemichannel pannexin 1 (PANX1) opens and forms a pore complex with the ligand-gated cation channel P2X7, allowing the release of excitatory neurotransmitters to sustain spreading depolarization and activate neuroinflammation. Here, we explore the hypothesis that the P2X7-PANX1 pore complex is a critical determinant of spreading depolarization susceptibility with important consequences for neuroinflammation and trigeminovascular activation. We found that genetic loss of function or ablation of the P2x7 gene inhibits spreading depolarization. Moreover, pharmacological suppression of the P2X7-PANX1 pore complex inhibits spreading depolarization in mice carrying the human familial hemiplegic migraine type 1 R192Q missense mutation as well as in wild-type mice and rats. Pore inhibitors elevate the electrical threshold for spreading depolarization, and reduce spreading depolarization frequency and amplitude. Pore inhibitors also suppress downstream consequences of spreading depolarization such as upregulation of interleukin-1 beta, inducible nitric oxide synthase and cyclooxygenase-2 in the cortex after spreading depolarization. In addition, they inhibit surrogates for trigeminovascular activation, including expression of calcitonin gene-related peptide in the trigeminal ganglion and c-Fos in the trigeminal nucleus caudalis. Our results are consistent with the hypothesis that the P2X7-PANX1 pore complex is a critical determinant of spreading depolarization susceptibility and its downstream consequences, of potential relevance to its signature disorders such as migraine.
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Affiliation(s)
- Shih-Pin Chen
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tao Qin
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jessica L Seidel
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Yi Zheng
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA and Universitaet Duisburg Essen, Essen, Germany
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Michael A Moskowitz
- Stroke and Neurovascular Regulation Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Cenk Ayata
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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16
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Timm FP, Houle TT, Grabitz SD, Lihn AL, Stokholm JB, Eikermann-Haerter K, Nozari A, Kurth T, Eikermann M. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ 2017; 356:i6635. [PMID: 28073753 PMCID: PMC5225233 DOI: 10.1136/bmj.i6635] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN Prospective hospital registry study. SETTING Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014. PARTICIPANTS 124 558 surgical patients (mean age 52.6 years; 54.5% women). MAIN OUTCOME MEASURES The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. RESULTS 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41). CONCLUSIONS Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative ischemic stroke.
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Affiliation(s)
- Fanny P Timm
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Anne-Louise Lihn
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Janne B Stokholm
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | | | - Ala Nozari
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Germany
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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17
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Abstract
Migraine is a highly prevalent and disabling neurological disorder with a strong genetic component. Rare monogenic forms of migraine, or syndromes in which migraine frequently occurs, help scientists to unravel pathogenetic mechanisms of migraine and its comorbidities. Transgenic mouse models for rare monogenic mutations causing familial hemiplegic migraine (FHM), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and familial advanced sleep-phase syndrome (FASPS), have been created. Here, we review the current state of research using these mutant mice. We also discuss how currently available experimental approaches, including epigenetic studies, biomolecular analysis and optogenetic technologies, can be used for characterization of migraine genes to further unravel the functional and molecular pathways involved in migraine.
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Affiliation(s)
- Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Else A Tolner
- Departments of Human Genetics and Neurology, Leiden University Medical Centre, the Netherlands
| | - Katharina Eikermann-Haerter
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, USA
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18
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von Bornstädt D, Eikermann-Haerter K. Migraine, Chronic Vasculopathies, and Spreading Depolarization. Headache 2016; 56:580-3. [PMID: 26995707 DOI: 10.1111/head.12753] [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] [Received: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel von Bornstädt
- Department of Radiology, Neurovascular Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Eikermann-Haerter
- Department of Radiology, Neurovascular Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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19
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Mawet J, Eikermann-Haerter K, Park KY, Helenius J, Daneshmand A, Pearlman L, Avery R, Negro A, Velioglu M, Arsava EM, Ay H, Ayata C. Sensitivity to acute cerebral ischemic injury in migraineurs: A retrospective case-control study. Neurology 2015; 85:1945-9. [PMID: 26537055 DOI: 10.1212/wnl.0000000000002166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/08/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Migraine, particularly with aura, is a risk factor for ischemic stroke. Recent data in migraine mutant mice suggest that cerebral hyperexcitability associated with migraine accelerates recruitment of ischemic penumbra into the core, resulting in faster infarct growth compared with wild type. We hypothesized that individuals with a history of migraine are more likely to exhibit increased recruitment of ischemic tissue into the infarct in acute stroke. METHODS In this retrospective case-control study, we identified participants with reliably documented migraine history, measured lesion volumes on diffusion-weighted and perfusion-weighted MRI obtained within 72 hours of symptom onset, calculated the proportion of ischemic tissue on perfusion-weighted imaging (PWI) hyperintense on diffusion-weighted imaging (DWI), and compared the proportion of patients with no-mismatch pattern defined as DWI lesion >83% of PWI lesion. RESULTS Migraineurs (n = 45) were younger, more often female, less likely to have vascular risk factors, and more often had cervical artery dissection, but otherwise did not differ from controls (n = 27). A significantly larger proportion of migraineurs had no-mismatch pattern, indicating that the entire perfusion defect was recruited into the infarct by the time of MRI (22% vs 4% of migraineurs and controls, respectively; p = 0.044). The difference was even more prominent in migraineurs with aura (36% vs 4%, p = 0.019). The association between migraine and no-mismatch pattern persisted after adjustment for time to MRI (p = 0.041). CONCLUSIONS This case-control study supports the hypothesis that a history of migraine, particularly with aura, is associated with a no-mismatch pattern during acute ischemic stroke, consistent with data obtained in migraine mutant mice.
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Affiliation(s)
- Jerome Mawet
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Katharina Eikermann-Haerter
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Kwang-Yeol Park
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Johanna Helenius
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Ali Daneshmand
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Lea Pearlman
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Ross Avery
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Andrea Negro
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Murat Velioglu
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Ethem Murat Arsava
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France
| | - Hakan Ay
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France.
| | - Cenk Ayata
- From the Neurovascular Research Laboratory, Department of Radiology (J.M., K.E.-H., A.D., L.P., A.N., C.A.), Martinos Center for Biomedical Imaging and Stroke Service (K.-Y.P., J.H., R.A., M.V., E.M.A., H.A.), and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology (C.A.), Massachusetts General Hospital, Harvard Medical School, Charlestown; and Emergency Headache Center (J.M.), Lariboisière Hospital, APHP, DHU Neurovasc Sorbonne Paris-Cité, Paris, France.
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20
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Mawet J, Eikermann-Haerter K, Park K, Helenius J, Daneshmand A, Pearlman L, Avery R, Negro A, Velioglu M, Arsava E, Ay H, Ayata C. Migraine modulates the evolution of penumbra in acute ischemic stroke. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.168] [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: 11/26/2022]
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21
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Srinivasan VJ, Yu E, Radhakrishnan H, Can A, Climov M, Leahy C, Ayata C, Eikermann-Haerter K. Micro-heterogeneity of flow in a mouse model of chronic cerebral hypoperfusion revealed by longitudinal Doppler optical coherence tomography and angiography. J Cereb Blood Flow Metab 2015; 35:1552-60. [PMID: 26243708 PMCID: PMC4640323 DOI: 10.1038/jcbfm.2015.175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/05/2015] [Accepted: 06/19/2015] [Indexed: 11/09/2022]
Abstract
Although microvascular dysfunction accompanies cognitive decline in aging, vascular dementia, and Alzheimer's disease, tools to study microvasculature longitudinally in vivo are lacking. Here, we use Doppler optical coherence tomography (OCT) and angiography for noninvasive, longitudinal imaging of mice with chronic cerebral hypoperfusion for up to 1 month. In particular, we optimized the OCT angiography method to selectively image red blood cell (RBC)-perfused capillaries, leading to a novel way of assessing capillary supply heterogeneity in vivo. After bilateral common carotid artery stenosis (BCAS), cortical blood flow measured by Doppler OCT dropped to half of baseline throughout the imaged tissue acutely. Microscopic imaging of the capillary bed with OCT angiography further revealed local heterogeneities in cortical flow supply during hypoperfusion. The number of RBC-perfused capillaries decreased, leading to increased oxygen diffusion distances in the days immediately after BCAS. Linear regression showed that RBC-perfused capillary density declined by 0.3% for a drop in flow of 1 mL/100 g per minute, and decreases in RBC-perfused capillary density as high as 25% were observed. Taken together, these results demonstrate the existence of local supply heterogeneity at the capillary level even at nonischemic global flow levels, and demonstrate a novel imaging method to assess this heterogeneity.
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Affiliation(s)
- Vivek J Srinivasan
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Esther Yu
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Harsha Radhakrishnan
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Anil Can
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Mihail Climov
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Conor Leahy
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
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22
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Eikermann-Haerter K, Arbel-Ornath M, Yalcin N, Yu ES, Kuchibhotla KV, Yuzawa I, Hudry E, Willard CR, Climov M, Keles F, Belcher AM, Sengul B, Negro A, Rosen IA, Arreguin A, Ferrari MD, van den Maagdenberg AMJM, Bacskai BJ, Ayata C. Abnormal synaptic Ca(2+) homeostasis and morphology in cortical neurons of familial hemiplegic migraine type 1 mutant mice. Ann Neurol 2015; 78:193-210. [PMID: 26032020 DOI: 10.1002/ana.24449] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Migraine is among the most common and debilitating neurological conditions. Familial hemiplegic migraine type 1 (FHM1), a monogenic migraine subtype, is caused by gain-of-function of voltage-gated CaV 2.1 calcium channels. FHM1 mice carry human pathogenic mutations in the α1A subunit of CaV 2.1 channels and are highly susceptible to cortical spreading depression (CSD), the electrophysiologic event underlying migraine aura. To date, however, the mechanism underlying increased CSD/migraine susceptibility remains unclear. METHODS We employed in vivo multiphoton microscopy of the genetically encoded Ca(2+)-indicator yellow cameleon to investigate synaptic morphology and [Ca(2+)]i in FHM1 mice. To study CSD-induced cerebral oligemia, we used in vivo laser speckle flowmetry and multimodal imaging. With electrophysiologic recordings, we investigated the effect of the CaV 2.1 gating modifier tert-butyl dihydroquinone on CSD in vivo. RESULTS FHM1 mutations elevate neuronal [Ca(2+)]i and alter synaptic morphology as a mechanism for enhanced CSD susceptibility that we were able to normalize with a CaV 2.1 gating modifier in hyperexcitable FHM1 mice. At the synaptic level, axonal boutons were larger, and dendritic spines were predominantly of the mushroom type, which both provide a structural correlate for enhanced neuronal excitability. Resting neuronal [Ca(2+)]i was elevated in FHM1, with loss of compartmentalization between synapses and neuronal shafts. The percentage of calcium-overloaded neurons was increased. Neuronal [Ca(2+)]i surge during CSD was faster and larger, and post-CSD oligemia and hemoglobin desaturation were more severe in FHM1 brains. INTERPRETATION Our findings provide a mechanism for enhanced CSD susceptibility in hemiplegic migraine. Abnormal synaptic Ca(2+) homeostasis and morphology may contribute to chronic neurodegenerative changes as well as enhanced vulnerability to ischemia in migraineurs.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Michal Arbel-Ornath
- Alzheimer Disease Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Nilufer Yalcin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Esther S Yu
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Kishore V Kuchibhotla
- Alzheimer Disease Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Izumi Yuzawa
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Eloise Hudry
- Alzheimer Disease Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Carli R Willard
- Alzheimer Disease Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Mihail Climov
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Fatmagul Keles
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Arianna M Belcher
- Alzheimer Disease Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Buse Sengul
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Andrea Negro
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Isaac A Rosen
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Andrea Arreguin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Brian J Bacskai
- Alzheimer Disease Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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23
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von Bornstädt D, Houben T, Seidel JL, Zheng Y, Dilekoz E, Qin T, Sandow N, Kura S, Eikermann-Haerter K, Endres M, Boas DA, Moskowitz MA, Lo EH, Dreier JP, Woitzik J, Sakadžić S, Ayata C. Supply-demand mismatch transients in susceptible peri-infarct hot zones explain the origins of spreading injury depolarizations. Neuron 2015; 85:1117-31. [PMID: 25741731 DOI: 10.1016/j.neuron.2015.02.007] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/01/2014] [Accepted: 01/23/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED Peri-infarct depolarizations (PIDs) are seemingly spontaneous spreading depression-like waves that negatively impact tissue outcome in both experimental and human stroke. Factors triggering PIDs are unknown. Here, we show that somatosensory activation of peri-infarct cortex triggers PIDs when the activated cortex is within a critical range of ischemia. We show that the mechanism involves increased oxygen utilization within the activated cortex, worsening the supply-demand mismatch. We support the concept by clinical data showing that mismatch predisposes stroke patients to PIDs as well. Conversely, transient worsening of mismatch by episodic hypoxemia or hypotension also reproducibly triggers PIDs. Therefore, PIDs are triggered upon supply-demand mismatch transients in metastable peri-infarct hot zones due to increased demand or reduced supply. Based on the data, we propose that minimizing sensory stimulation and hypoxic or hypotensive transients in stroke and brain injury would reduce PID incidence and their adverse impact on outcome. VIDEO ABSTRACT
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Affiliation(s)
- Daniel von Bornstädt
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA; Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Center for Stroke Research, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thijs Houben
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA; Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands
| | - Jessica L Seidel
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Yi Zheng
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Ergin Dilekoz
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA; Department of Pharmacology, Gazi University Faculty of Medicine, Besevler Campus, 06560 Ankara, Turkey
| | - Tao Qin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Nora Sandow
- Department of Neurosurgery, Charité - Universitätsmedizin Augustenburger Platz 1, 13353 Berlin, Germany; Center for Stroke Research, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sreekanth Kura
- Optics Division, MHG/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Matthias Endres
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Center for Stroke Research, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - David A Boas
- Optics Division, MHG/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Michael A Moskowitz
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Eng H Lo
- Neuroprotection Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Jens P Dreier
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Center for Stroke Research, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Charité - Universitätsmedizin Augustenburger Platz 1, 13353 Berlin, Germany; Center for Stroke Research, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sava Sakadžić
- Optics Division, MHG/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13(th) Street, 6408, Charlestown, MA 02129, USA; Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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24
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von Bornstädt D, Seidel J, Houben MB, Dilekoz E, Qin T, Sandow N, Eikermann-Haerter K, Boas D, Moskowitz M, Lo E, Dreier J, Woitzik J, Sakadzic S, Ayata C. Abstract W MP91: Supply-demand Mismatch Transients Trigger Peri-infarct Depolarizations In Ischemic Penumbra. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Peri-infarct depolarizations (PIDs) worsen the outcome of ischemic stroke. Unlike their impact on metabolism and perfusion, triggering factors are virtually unknown. We hypothesized that transient worsening of O2 supply-demand mismatch precipitates a PID in critically hypoperfused penumbra.
Methods:
We optically imaged cortical blood flow and oxygenation during distal middle cerebral artery occlusion in mice under full systemic physiological monitoring, and tested whether a transient (5 min) drop in O2 supply (hypotension or hypoxia) or increase in O2 demand (somatosensory cortical activation) can trigger PIDs during acute focal cerebral ischemia.
Results:
Transient hypotension (<70 mmHg) or hypoxia (<90 mmHg) triggered a PID 90% of the time (p<0.01). Increasing the O2 demand by functional activation (tactile stimulation) of moderately ischemic cortex (contralesional forepaw or shoulder S1) increased the 5-min incidence of PIDs by approximately five-fold (p=0.001). Cortical oxyhemoglobin levels dropped by 35-40% in the activated S1 immediately before a PID (p=0.004) confirming increased O2 demand. Cortical foci from which PIDs originated during tactile stimulation had 27-32% residual CBF, indicating the presence of a critical range of ischemia vulnerable to PID initiation upon increased demand. Consistently, activation of non-ischemic cortex (hindpaw S1) or severely ischemic cortex (whisker S1) did not significantly increase the PID rate. Both tetrodotoxin (1 μM topical) and normobaric hyperoxia prevented somatosensory triggering of PIDs.
Conclusion:
PIDs are triggered upon O2 supply-demand mismatch transients in metastable peri-infarct hot zones due to increased demand or reduced supply. We propose that minimizing sensory stimulation and hypoxic or hypotensive transients in the early stages of stroke and brain injury would reduce PID incidence and their adverse impact on outcome.
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Affiliation(s)
| | - Jessica Seidel
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
| | | | - Ergin Dilekoz
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
| | - Tao Qin
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
| | - Nora Sandow
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - David Boas
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
| | | | - Eng Lo
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
| | - Jens Dreier
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Sava Sakadzic
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
| | - Cenk Ayata
- Massachusetts General Hosp, Harvard Med Sch, Charlestown, MA
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25
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Eikermann-Haerter K, Lee JH, Yalcin N, Yu ES, Daneshmand A, Wei Y, Zheng Y, Can A, Sengul B, Ferrari MD, van den Maagdenberg AMJM, Ayata C. Migraine prophylaxis, ischemic depolarizations, and stroke outcomes in mice. Stroke 2014; 46:229-36. [PMID: 25424478 DOI: 10.1161/strokeaha.114.006982] [Citation(s) in RCA: 31] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Migraine with aura is an established stroke risk factor, and excitatory mechanisms such as spreading depression (SD) are implicated in the pathogenesis of both migraine and stroke. Spontaneous SD waves originate within the peri-infarct tissue and exacerbate the metabolic mismatch during focal cerebral ischemia. Genetically enhanced SD susceptibility facilitates anoxic depolarizations and peri-infarct SDs and accelerates infarct growth, suggesting that susceptibility to SD is a critical determinant of vulnerability to ischemic injury. Because chronic treatment with migraine prophylactic drugs suppresses SD susceptibility, we tested whether migraine prophylaxis can also suppress ischemic depolarizations and improve stroke outcome. METHODS We measured the cortical susceptibility to SD and ischemic depolarizations, and determined tissue and neurological outcomes after middle cerebral artery occlusion in wild-type and familial hemiplegic migraine type 1 knock-in mice treated with vehicle, topiramate or lamotrigine daily for 7 weeks or as a single dose shortly before testing. RESULTS Chronic treatment with topiramate or lamotrigine reduced the susceptibility to KCl-induced or electric stimulation-induced SDs as well as ischemic depolarizations in both wild-type and familial hemiplegic migraine type 1 mutant mice. Consequently, both tissue and neurological outcomes were improved. Notably, treatment with a single dose of either drug was ineffective. CONCLUSIONS These data underscore the importance of hyperexcitability as a mechanism for increased stroke risk in migraineurs, and suggest that migraine prophylaxis may not only prevent migraine attacks but also protect migraineurs against ischemic injury.
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Affiliation(s)
- Katharina Eikermann-Haerter
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Jeong Hyun Lee
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Nilufer Yalcin
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Esther S Yu
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Ali Daneshmand
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Ying Wei
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Yi Zheng
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Anil Can
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Buse Sengul
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Michel D Ferrari
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Arn M J M van den Maagdenberg
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.)
| | - Cenk Ayata
- From the Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown (K.E.-H., J.H.L., N.Y., E.S.Y., A.D., Y.W., Y.Z., A.C., B.S., C.A.); Department of Neurology (M.D.F., A.M.J.M.v.d.M), and Department of Human Genetics, Leiden University Medical Centre, The Netherlands (A.M.J.M.v.d.M); and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.).
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26
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Shyti R, Eikermann-Haerter K, van Heiningen SH, Meijer OC, Ayata C, Joëls M, Ferrari MD, van den Maagdenberg AMJM, Tolner EA. Stress hormone corticosterone enhances susceptibility to cortical spreading depression in familial hemiplegic migraine type 1 mutant mice. Exp Neurol 2014; 263:214-20. [PMID: 25447936 DOI: 10.1016/j.expneurol.2014.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 05/05/2014] [Revised: 09/25/2014] [Accepted: 10/22/2014] [Indexed: 01/10/2023]
Abstract
Stress is a putative migraine trigger, but the pathogenic mechanisms involved are unknown. Stress and stress hormones increase neuronal excitability by enhancing glutamatergic neurotransmission, but inhibitory effects have also been reported. We hypothesise that an acute rise in stress hormones, such as corticosteroids which are released after stress, increase neuronal excitability and thereby may increase susceptibility to cortical spreading depression (CSD), the mechanism underlying the migraine aura. Here we investigated effects of acute restraint stress and of the stress hormone corticosterone on CSD susceptibility as surrogate migraine marker, in a transgenic mouse model of familial hemiplegic migraine type 1 (FHM1), which displays increased glutamatergic cortical neurotransmission and increased propensity for CSD. We found that 20-min and 3-h restraint stress did not influence CSD susceptibility in mutant or wild-type mice, despite elevated levels of plasma corticosterone. By contrast, subcutaneous administration of 20mg/kg corticosterone increased CSD frequency exclusively in mutant mice, while corticosterone plasma levels were similarly elevated in mutants and wild types. The effect of corticosterone on CSD frequency was normalised by pre-administration of the glucocorticoid receptor (GR) antagonist mifepristone. These findings suggest that corticosteroid-induced GR activation can enhance susceptibility to CSD in genetically susceptible individuals, and may predispose to attacks of migraine. Although corticosterone levels rise also during acute stress, the latter likely triggers a spatiotemporally more complex biological response with multiple positive and negative modulators which may not be adequately modeled by exogenous administration of corticosterone alone.
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Affiliation(s)
- Reinald Shyti
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Katharina Eikermann-Haerter
- Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, MA General Hospital, Harvard Medical School, Charlestown, USA
| | | | - Onno C Meijer
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, MA General Hospital, Harvard Medical School, Charlestown, USA; Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, MA General Hospital, Harvard Medical School, Charlestown, USA
| | - Marian Joëls
- Department of Neuroscience and Pharmacology, University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Migraine increases the risk of stroke, particularly in young and otherwise healthy adults. Being the most frequent neurological condition, migraine prevalence is on a par with that of other common stroke risk factors, such as diabetes or hypertension. Several patterns of association have emerged: (1) migraine and stroke share a common association (eg, vasculopathies, patent foramen ovale, or pulmonary A-V malformations); (2) injury to the arterial wall such as acute arterial dissections can present as migraine aura attacks or stroke; (3) strokes rarely develop during a migraine attack, as described for "migrainous stroke." Increasing experimental evidence suggests that cerebral hyperexcitability and enhanced susceptibility to spreading depolarization, the electrophysiologic event underlying migraine, may serve as a mechanism underlying the migraine-stroke association. Mice carrying human vascular or neuronal migraine mutations exhibit an enhanced susceptibility to spreading depolarization while being particularly vulnerable to cerebral ischemia. The severe stroke phenotype in migraine mutant mice can be prevented by suppressing spreading depolarization. If confirmed in the clinical setting, inhibiting spreading depolarization might protect migraineurs at stroke risk as well as decrease attacks of migraine.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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28
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Eikermann-Haerter K, Park K, Helenius J, Velioglu M, Daneshmand A, Arsava M, Pearlman L, Ross A, Negro A, Ayata C, Ay H. Abstract 116: Migraineurs Are More Susceptible to Infarct Growth in Acute Stroke. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological data indicate that migraine is an independent stroke risk factor. Recent data suggest that migraine mutations increase brain vulnerability to ischemia via excitatory mechanisms (Circulation 2012; 125:335). Migraine mutant mice developed higher number of ischemic depolarizations and accelerated infarct growth during hyperacute stroke, with worse tissue and neurological outcomes.
Here, we retrospectively assessed acute stroke evolution in patients with a reliably documented migraine history. In a blinded fashion, we analyzed the lesion volume on diffusion-weighted imaging (DWI), and the volume of perfusion defect on perfusion-weighted imaging (PWI) using mean transit time (MTT), from consecutive patients during the years 2003-2012 in the Massachusetts General Hospital stroke database. DWI-PWI mismatch was calculated on spatially co-registered DWI and MTT maps, as a marker for viable tissue at risk for infarction.
A total of 155 stroke patients had reliably documented presence or absence of a migraine history. Stroke patients with a history of migraine were younger and more often female, compared to stroke patients who never suffered from migraine. Migraineurs less frequently had coronary artery disease or diabetes. The frequency of posterior circulation lesions was significantly higher in migraineurs. Otherwise, groups were comparable.
In migraineurs with aura, a larger proportion of the perfusion defect showed DWI changes, resulting in smaller DWI/PWI mismatches. A significantly larger proportion of migraineurs with aura showed no mismatch (i.e., DWI/PWI>0.9), indicating that the entire perfusion defect was already infarcted (Table).
Our data show that a history of migraine, particularly with aura, is associated with accelerated acute infarct growth, consistent with data obtained in migraine mutant mice.
[Table. Diffusion-perfusion mismatch. *p=0.011 migraine vs no migraine,
†
p=0.002 migraine with aura vs no migraine]
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Affiliation(s)
| | | | | | | | | | | | | | - Avery Ross
- Massachusetts General Hosp, Charlestown, MA
| | | | - Cenk Ayata
- Massachusetts General Hosp, Charlestown, MA
| | - Hakan Ay
- Massachusetts General Hosp, Charlestown, MA
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29
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Eikermann-Haerter K, Negro A, Ayata C. Spreading depression and the clinical correlates of migraine. Rev Neurosci 2013; 24:353-63. [PMID: 23907418 DOI: 10.1515/revneuro-2013-0005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/27/2013] [Indexed: 12/14/2022]
Abstract
Migraine is the most common neurologic condition. One-third of migraineurs experience transient neurologic symptoms, the so-called aura. There is strong evidence that spreading depression (SD) is the electrophysiologic substrate of migraine aura. SD is an intense pan-depolarization wave that slowly propagates in gray matter by way of contiguity and transiently disrupts neuronal function. When induced subcortically, striatal SD causes hemiparesis, hippocampal SD can trigger seizures and impact cognition, and bilateral thalamic SD can diminish consciousness. Recent data show that transgenic mice expressing familial hemiplegic migraine (FHM) type 1 mutations in voltage-gated Ca2+ channels (Cav2.1) develop mutation-specific aura-like signs after a cortical SD similar to patients with the respective mutation. These signs are associated with facilitated subcortical SD propagation. As in FHM, mice with the R192Q mutation develop pure hemiplegia associated with cortical SDs propagating into caudoputamen. S218L mice display additional signs such as seizures and coma when SD propagates into hippocampus and thalamus. In hyperexcitable FHM brains, SD may propagate between cortex and subcortical structures via permissive gray matter bridges, or originate de novo in subcortical structures, to explain unusual and severe aura signs and symptoms. Reciprocal spread and reverberating waves can explain protracted attacks.
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30
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Arbel-Ornath M, Hudry E, Eikermann-Haerter K, Hou S, Gregory JL, Zhao L, Betensky RA, Frosch MP, Greenberg SM, Bacskai BJ. Interstitial fluid drainage is impaired in ischemic stroke and Alzheimer's disease mouse models. Acta Neuropathol 2013; 126:353-64. [PMID: 23818064 DOI: 10.1007/s00401-013-1145-2] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 12/19/2022]
Abstract
The interstitial fluid (ISF) drainage pathway has been hypothesized to underlie the clearance of solutes and metabolites from the brain. Previous work has implicated the perivascular spaces along arteries as the likely route for ISF clearance; however, it has never been demonstrated directly. The accumulation of amyloid β (Aβ) peptides in brain parenchyma is one of the pathological hallmarks of Alzheimer disease (AD), and it is likely related to an imbalance between production and clearance of the peptide. Aβ drainage along perivascular spaces has been postulated to be one of the mechanisms that mediate the peptide clearance from the brain. We therefore devised a novel method to visualize solute clearance in real time in the living mouse brain using laser guided bolus dye injections and multiphoton imaging. This methodology allows high spatial and temporal resolution and revealed the kinetics of ISF clearance. We found that the ISF drains along perivascular spaces of arteries and capillaries but not veins, and its clearance exhibits a bi-exponential profile. ISF drainage requires a functional vasculature, as solute clearance decreased when perfusion was impaired. In addition, reduced solute clearance was observed in transgenic mice with significant vascular amyloid deposition; we suggest the existence of a feed-forward mechanism, by which amyloid deposition promotes further amyloid deposition. This important finding provides a mechanistic link between cerebrovascular disease and Alzheimer disease and suggests that facilitation of Aβ clearance along the perivascular pathway should be considered as a new target for therapeutic approaches to Alzheimer disease and cerebral amyloid angiopathy.
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Affiliation(s)
- Michal Arbel-Ornath
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
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31
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Srinivasan VJ, Mandeville ET, Can A, Blasi F, Climov M, Daneshmand A, Lee JH, Yu E, Radhakrishnan H, Lo EH, Sakadžić S, Eikermann-Haerter K, Ayata C. Multiparametric, longitudinal optical coherence tomography imaging reveals acute injury and chronic recovery in experimental ischemic stroke. PLoS One 2013; 8:e71478. [PMID: 23940761 PMCID: PMC3737090 DOI: 10.1371/journal.pone.0071478] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 06/28/2013] [Indexed: 11/19/2022] Open
Abstract
Progress in experimental stroke and translational medicine could be accelerated by high-resolution in vivo imaging of disease progression in the mouse cortex. Here, we introduce optical microscopic methods that monitor brain injury progression using intrinsic optical scattering properties of cortical tissue. A multi-parametric Optical Coherence Tomography (OCT) platform for longitudinal imaging of ischemic stroke in mice, through thinned-skull, reinforced cranial window surgical preparations, is described. In the acute stages, the spatiotemporal interplay between hemodynamics and cell viability, a key determinant of pathogenesis, was imaged. In acute stroke, microscopic biomarkers for eventual infarction, including capillary non-perfusion, cerebral blood flow deficiency, altered cellular scattering, and impaired autoregulation of cerebral blood flow, were quantified and correlated with histology. Additionally, longitudinal microscopy revealed remodeling and flow recovery after one week of chronic stroke. Intrinsic scattering properties serve as reporters of acute cellular and vascular injury and recovery in experimental stroke. Multi-parametric OCT represents a robust in vivo imaging platform to comprehensively investigate these properties.
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Affiliation(s)
- Vivek J Srinivasan
- Biomedical Engineering Department, University of California Davis, Davis, California, United States of America.
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Ayata C, Shin HK, Dileköz E, Atochin DN, Kashiwagi S, Eikermann-Haerter K, Huang PL. Hyperlipidemia disrupts cerebrovascular reflexes and worsens ischemic perfusion defect. J Cereb Blood Flow Metab 2013; 33:954-62. [PMID: 23486293 PMCID: PMC3677117 DOI: 10.1038/jcbfm.2013.38] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 11/09/2022]
Abstract
Hyperlipidemia is a highly prevalent risk factor for coronary and cervical atherosclerosis and stroke. However, even in the absence of overt atherosclerosis, hyperlipidemia disrupts endothelial and smooth muscle function. We investigated the impact of hyperlipidemia on resting-brain perfusion, fundamental cerebrovascular reflexes, and dynamic perfusion defect during acute focal ischemia in hyperlipidemic apolipoprotein E knockout mice before the development of flow-limiting atherosclerotic stenoses. Despite elevated blood pressures, absolute resting cerebral blood flow was reduced by 20% in apolipoprotein E knockout compared with wild type when measured by [(14)C]-iodoamphetamine technique. Noninvasive, high spatiotemporal resolution laser speckle flow imaging revealed that the lower autoregulatory limit was elevated in apolipoprotein E knockout mice (60 vs. 40 mm Hg), and cortical hyperemic responses to hypercapnia and functional activation were attenuated by 30% and 64%, respectively. Distal middle cerebral artery occlusion caused significantly larger perfusion defects and infarct volumes in apolipoprotein E knockout compared with wild type. Cerebrovascular dysfunction showed a direct relationship to the duration of high-fat diet. These data suggest that hyperlipidemia disrupts cerebral blood flow regulation and diminishes collateral perfusion in acute stroke in the absence of hemodynamically significant atherosclerosis.
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Affiliation(s)
- Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown 02129, Massachusetts, USA.
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33
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Shyti R, Eikermann-Haerter K, Meijer OC, van Heiningen SH, De Groote L, Ferrari MD, Ayata C, van den Maagdenberg AMJ, Tolner EA. Corticosterone enhances CSD susceptibility via glucocorticoid receptor activation in familial hemiplegic migraine 1 Cacna1a knock-in mice. J Headache Pain 2013. [PMCID: PMC3620500 DOI: 10.1186/1129-2377-14-s1-p85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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34
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Hoffmann U, Sukhotinsky I, Atalay YB, Eikermann-Haerter K, Ayata C. Increased glucose availability does not restore prolonged spreading depression durations in hypotensive rats without brain injury. Exp Neurol 2012; 238:130-2. [PMID: 22981452 DOI: 10.1016/j.expneurol.2012.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/31/2012] [Accepted: 08/11/2012] [Indexed: 10/28/2022]
Abstract
Maintenance of transmembrane ionic gradients and their restoration after cortical spreading depression (CSD) are energy dependent. We recently showed an inverse relationship between blood pressure and CSD duration that is independent of tissue oxygenation. Here, we tested the alternative hypothesis that glucose availability becomes rate-limiting for CSD recovery upon reduced blood pressure in anesthetized rats under full systemic physiological monitoring. Hypotension induced by controlled exsanguination significantly prolonged CSD durations, reduced propagation speeds, and diminished the blood flow response. Hyperglycemia failed to restore the prolonged CSD durations in hypotensive rats and did not significantly alter the propagation speed or the blood flow response. These data suggest that prolonged CSD durations during reduced cerebral perfusion pressure are independent of tissue energy status, and implicate alternative mechanisms of CSD recovery such as vascular clearance of extracellular K(+).
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Affiliation(s)
- Ulrike Hoffmann
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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35
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Abstract
Migraine, particularly with aura, is a genetically heterogeneous disorder of ion channels, pumps or transporters associated with increased cortical excitability. Spreading depression, as one reflection of hyperexcitability, is the electrophysiological event underlying aura symptoms and a trigger for headache. Endogenous (e.g., genes and hormones) and exogenous factors (e.g., drugs) modulating migraine susceptibility have also been shown to modulate spreading depression susceptibility concordantly, suggesting that spreading depression can be a relevant therapeutic target in migraine. In support of this, several migraine prophylactic drugs used in clinical practice have been shown to suppress spreading depression susceptibility as a probable mechanism of action, despite belonging to widely different pharmacological classes. Hence, susceptibility to spreading depression can be a useful preclinical model with good positive and negative predictive value for drug screening.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Charleston, MA 02129, USA.
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36
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Yuzawa I, Sakadžić S, Srinivasan VJ, Shin HK, Eikermann-Haerter K, Boas DA, Ayata C. Cortical spreading depression impairs oxygen delivery and metabolism in mice. J Cereb Blood Flow Metab 2012; 32:376-86. [PMID: 22008729 PMCID: PMC3272607 DOI: 10.1038/jcbfm.2011.148] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/26/2011] [Accepted: 09/20/2011] [Indexed: 01/28/2023]
Abstract
Cortical spreading depression (CSD) is associated with severe hypoperfusion in mice. Using minimally invasive multimodal optical imaging, we show that severe flow reductions during and after spreading depression are associated with a steep decline in cerebral metabolic rate of oxygen. Concurrent severe hemoglobin desaturation suggests that the oxygen metabolism becomes at least in part supply limited, and the decrease in cortical blood volume implicates vasoconstriction as the mechanism. In support of oxygen supply-demand mismatch, cortical nicotinamide adenine dinucleotide (NADH) fluorescence increases during spreading depression for at least 5 minutes, particularly away from parenchymal arterioles. However, modeling of tissue oxygen delivery shows that cerebral metabolic rate of oxygen drops more than predicted by a purely supply-limited model, raising the possibility of a concurrent reduction in oxygen demand during spreading depression. Importantly, a subsequent spreading depression triggered within 15 minutes evokes a monophasic flow increase superimposed on the oligemic baseline, which markedly differs from the response to the preceding spreading depression triggered in naive cortex. Altogether, these data suggest that CSD is associated with long-lasting oxygen supply-demand mismatch linked to severe vasoconstriction in mice.
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Affiliation(s)
- Izumi Yuzawa
- Department of Radiology, Neurovascular Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Sava Sakadžić
- Optics Division, MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Vivek J Srinivasan
- Optics Division, MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Hwa Kyoung Shin
- Department of Radiology, Neurovascular Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Katharina Eikermann-Haerter
- Department of Radiology, Neurovascular Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - David A Boas
- Optics Division, MGH/MIT/HMS Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Cenk Ayata
- Department of Radiology, Neurovascular Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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37
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Eikermann-Haerter K, Lee JH, Yuzawa I, Liu CH, Zhou Z, Shin HK, Zheng Y, Qin T, Kurth T, Waeber C, Ferrari MD, van den Maagdenberg AMJM, Moskowitz MA, Ayata C. Migraine mutations increase stroke vulnerability by facilitating ischemic depolarizations. Circulation 2011; 125:335-45. [PMID: 22144569 DOI: 10.1161/circulationaha.111.045096] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [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
BACKGROUND Migraine is an independent risk factor for stroke. Mechanisms underlying this association are unclear. Familial hemiplegic migraine (FHM), a migraine subtype that also carries an increased stroke risk, is a useful model for common migraine phenotypes because of shared aura and headache features, trigger factors, and underlying glutamatergic mechanisms. METHODS AND RESULTS Here, we show that FHM type 1 (FHM1) mutations in Ca(V)2.1 voltage-gated Ca(2+) channels render the brain more vulnerable to ischemic stroke. Compared with wild-type mice, 2 FHM1 mutant mouse strains developed earlier onset of anoxic depolarization and more frequent peri-infarct depolarizations associated with rapid expansion of infarct core on diffusion-weighted magnetic resonance imaging and larger perfusion deficits on laser speckle flowmetry. Cerebral blood flow required for tissue survival was higher in the mutants, leading to infarction with milder ischemia. As a result, mutants developed larger infarcts and worse neurological outcomes after stroke, which were selectively attenuated by a glutamate receptor antagonist. CONCLUSIONS We propose that enhanced susceptibility to ischemic depolarizations akin to spreading depression predisposes migraineurs to infarction during mild ischemic events, thereby increasing the stroke risk.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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38
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Sukhotinsky I, Dilekoz E, Wang Y, Qin T, Eikermann-Haerter K, Waeber C, Ayata C. Chronic daily cortical spreading depressions suppress spreading depression susceptibility. Cephalalgia 2011; 31:1601-8. [PMID: 22013142 DOI: 10.1177/0333102411425865] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Migraine is a disabling chronic episodic disorder. Attack frequency progressively increases in some patients. Incremental cortical excitability has been implicated as a mechanism underlying progression. Cortical spreading depression (CSD) is the electrophysiological event underlying migraine aura, and a headache trigger. We hypothesized that CSD events during frequent migraine attacks condition the cortex to increase the susceptibility to further attacks. METHODS A single daily CSD was induced for 1 or 2 weeks in mouse frontal cortex; contralateral hemisphere served as sham control. At the end of CSD conditioning, occipital CSD susceptibility was determined by measuring the frequency of CSDs evoked by topical KCl application. RESULTS Sham hemispheres developed 8.4 ± 0.3 CSDs/hour, and did not significantly differ from naïve controls without prior cranial surgery (9.3 ± 0.4 CSDs/hour). After 2 but not 1 week of daily CSD conditioning, CSD frequency (4.9 ± 0.3 CSDs/hour) as well as the duration and propagation speed were reduced significantly in the conditioned hemispheres. Histopathological examination revealed marked reactive astrocytosis without neuronal injury throughout the conditioned cortex after 2 weeks, temporally associated with CSD susceptibility. CONCLUSIONS These data do not support the hypothesis that frequent migraine attacks predispose the brain to further attacks by enhancing tissue susceptibility to CSD.
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39
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Eikermann-Haerter K, Yuzawa I, Dilekoz E, Joutel A, Moskowitz MA, Ayata C. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy syndrome mutations increase susceptibility to spreading depression. Ann Neurol 2011; 69:413-8. [PMID: 21387384 DOI: 10.1002/ana.22281] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Migraine with aura is often the first manifestation of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy syndrome (CADASIL), a disorder caused by NOTCH3 gene mutations expressed predominantly in vascular smooth muscle. Here, we report that cortical spreading depression (CSD), the electrophysiological substrate of migraine aura, is enhanced in mice expressing a vascular Notch 3 CADASIL mutation (R90C) or a Notch 3 knockout mutation. The phenotype was stronger in Notch 3 knockout mice, implicating both loss of function and neomorphic mutations in its pathogenesis. Our results link vascular smooth muscle Notch 3 mutations to enhanced spreading depression susceptibility, implicating the neurovascular unit in the development of migraine aura.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, USA
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40
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Nozari A, Dilekoz E, Sukhotinsky I, Stein T, Eikermann-Haerter K, Liu C, Wang Y, Frosch MP, Waeber C, Ayata C, Moskowitz MA. Microemboli may link spreading depression, migraine aura, and patent foramen ovale. Ann Neurol 2010; 67:221-9. [PMID: 20225282 PMCID: PMC2921919 DOI: 10.1002/ana.21871] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patent foramen ovale and pulmonary arteriovenous shunts are associated with serious complications such as cerebral emboli, stroke, and migraine with aura. The pathophysiological mechanisms that link these conditions are unknown. We aimed to establish a mechanism linking microembolization to migraine aura in an experimental animal model. METHODS We introduced particulate or air microemboli into the carotid circulation in mice to determine whether transient microvascular occlusion, insufficient to cause infarcts, triggered cortical spreading depression (CSD), a propagating slow depolarization that underlies migraine aura. RESULTS Air microemboli reliably triggered CSD without causing infarction. Polystyrene microspheres (10 microm) or cholesterol crystals (<70 microm) triggered CSD in 16 of 28 mice, with 60% of the mice (40% of those with CSD) showing no infarcts or inflammation on detailed histological analysis of serial brain sections. No evidence of injury was detected on magnetic resonance imaging examination (9.4T; T2 weighted) in 14 of 15 selected animals. The occurrence of CSD appeared to be related to the magnitude and duration of flow reduction, with a triggering mechanism that depended on decreased brain perfusion but not sustained tissue damage. INTERPRETATION In a mouse model, microemboli triggered CSD, often without causing microinfarction. Paradoxical embolization then may link cardiac and extracardiac right-to-left shunts to migraine aura. If translatable to humans, a subset of migraine auras may belong to a spectrum of hypoperfusion disorders along with transient ischemic attacks and silent infarcts.
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Affiliation(s)
- Ala Nozari
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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41
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Eikermann-Haerter K, Baum MJ, Ferrari MD, van den Maagdenberg AMJM, Moskowitz MA, Ayata C. Androgenic suppression of spreading depression in familial hemiplegic migraine type 1 mutant mice. Ann Neurol 2009; 66:564-8. [PMID: 19847904 DOI: 10.1002/ana.21779] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Familial hemiplegic migraine type 1 (FHM1), a severe migraine with aura variant, is caused by mutations in the CACNA1A gene. Mutant mice carrying the FHM1 R192Q mutation exhibit increased propensity for cortical spreading depression (CSD), a propagating wave of neuroglial depolarization implicated in migraine aura. The CSD phenotype is stronger in female R192Q mutants and diminishes after ovariectomy. Here, we show that orchiectomy reciprocally increases CSD susceptibility in R192Q mutant mice. Chronic testosterone replacement restores CSD susceptibility by an androgen receptor-dependent mechanism. Hence, androgens modulate genetically-enhanced CSD susceptibility and may provide a novel prophylactic target for migraine.
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42
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Eikermann-Haerter K, Dileköz E, Kudo C, Savitz SI, Waeber C, Baum MJ, Ferrari MD, van den Maagdenberg AM, Moskowitz MA, Ayata C. Genetic and hormonal factors modulate spreading depression and transient hemiparesis in mouse models of familial hemiplegic migraine type 1. J Clin Invest 2009; 119:99-109. [PMID: 19104150 PMCID: PMC2613474 DOI: 10.1172/jci36059] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 10/08/2008] [Indexed: 11/17/2022] Open
Abstract
Familial hemiplegic migraine type 1 (FHM1) is an autosomal dominant subtype of migraine with aura that is associated with hemiparesis. As with other types of migraine, it affects women more frequently than men. FHM1 is caused by mutations in the CACNA1A gene, which encodes the alpha1A subunit of Cav2.1 channels; the R192Q mutation in CACNA1A causes a mild form of FHM1, whereas the S218L mutation causes a severe, often lethal phenotype. Spreading depression (SD), a slowly propagating neuronal and glial cell depolarization that leads to depression of neuronal activity, is the most likely cause of migraine aura. Here, we have shown that transgenic mice expressing R192Q or S218L FHM1 mutations have increased SD frequency and propagation speed; enhanced corticostriatal propagation; and, similar to the human FHM1 phenotype, more severe and prolonged post-SD neurological deficits. The susceptibility to SD and neurological deficits is affected by allele dosage and is higher in S218L than R192Q mutants. Further, female S218L and R192Q mutant mice were more susceptible to SD and neurological deficits than males. This sex difference was abrogated by ovariectomy and senescence and was partially restored by estrogen replacement, implicating ovarian hormones in the observed sex differences in humans with FHM1. These findings demonstrate that genetic and hormonal factors modulate susceptibility to SD and neurological deficits in FHM1 mutant mice, providing a potential mechanism for the phenotypic diversity of human migraine and aura.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Ergin Dileköz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Chiho Kudo
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Sean I. Savitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Christian Waeber
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michael J. Baum
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michel D. Ferrari
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Arn M.J.M. van den Maagdenberg
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michael A. Moskowitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Cenk Ayata
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
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Liu CH, You Z, Ren J, Kim YR, Eikermann-Haerter K, Liu PK. Noninvasive delivery of gene targeting probes to live brains for transcription MRI. FASEB J 2007; 22:1193-203. [PMID: 18029447 DOI: 10.1096/fj.07-9557com] [Citation(s) in RCA: 23] [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] [Indexed: 12/11/2022]
Abstract
We aimed to test the feasibility of detecting gliosis in living brains when the blood-brain barrier (BBB) is disrupted. We designed a novel magnetic resonance (MR) probe that contains superparamagnetic iron oxide nanoparticles (SPION, a T2 susceptibility contrast agent) linked to a short DNA sequence complementary to the cerebral mRNA of glial fibrillary acidic protein (GFAP) found in glia and astrocytes. As a control, we also used a sequence complementary to the mRNA of beta-actin. Our objectives are to demonstrate that this new probe, SPION-gfap, could be delivered to the brain when administered by eyedrop solution to the conjunctival sac. We induced BBB leakage by puncture wound, global cerebral ischemia, and cortical spreading depression in C57BL6 mice; 1 day after probe delivery we acquired T2* MR images and R2* (R2* = 1/T2*) maps using a transcription MRI technique in live mice. We found that the SPION-gfap probe reported foci with elevated signal in subtraction R2* maps and that these foci matched areas identified as having extensive glial network (gliosis) in postmortem immunohistochemistry. Similarly, animals administered the control probe exhibited foci of R2* elevation that matched beta-actin-expressing endothelia in the vascular wall. We conclude that our modular MR probe, delivered in an eyedrop solution, effectively reports gliosis associated with acute neurological disorders in living animals. As BBB leakage is often observed in acute neurological disorders, this study also served to validate noninvasive delivery of MR probes to the brains of live animals after acute neurological disorders.
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Affiliation(s)
- Christina H Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
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Abstract
Cortical spreading depression (CSD) is an electrophysiological phenomenon characterized by a wave of excitation followed by inhibition. The aura phase that precedes migraine headache in about 20-30% of migraineurs shares overlapping characteristics with CSD. Studies of rare autosomal-dominant forms of migraine with aura provide strong evidence that the threshold for evoking CSD and aura are related to neuronal excitability. Although the relationship between CSD and migraine without aura is not completely understood, the molecular abnormalities that predispose to migraine with aura illustrate the importance of physiologic events associated with neuronal hyperexcitability, and provide a basis for understanding a more generalized view of migraine.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Department of Radiology, Stroke and Neurovascular Regulation Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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