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Chen C, Tang F, Zhu M, Wang C, Zhou H, Zhang C, Feng Y. Role of inflammatory mediators in intracranial aneurysms: A review. Clin Neurol Neurosurg 2024; 242:108329. [PMID: 38781806 DOI: 10.1016/j.clineuro.2024.108329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
The formation, growth, and rupture of intracranial aneurysms (IAs) involve hemodynamics, blood pressure, external stimuli, and a series of hormonal changes. In addition, inflammatory response causes the release of a series of inflammatory mediators, such as IL, TNF-α, MCP-1, and MMPs, which directly or indirectly promote the development process of IA. However, the specific role of these inflammatory mediators in the pathophysiological process of IA remains unclear. Recently, several anti-inflammatory, lipid-lowering, hormone-regulating drugs have been found to have a potentially protective effect on reducing IA formation and rupture in the population. These therapeutic mechanisms have not been fully elucidated, but we can look for potential therapeutic targets that may interfere with the formation and breakdown of IA by studying the relevant inflammatory response and the mechanism of IA formation and rupture involved in inflammatory mediators.
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Affiliation(s)
- Cheng Chen
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Fengjiao Tang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Meng Zhu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Han Zhou
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Chonghui Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China.
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2
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Kishizaki H, Nakajima H, Takasaki M, Hongo T, Fujimoto Y, Sakurai T. A rare intracranial fusiform thrombosed aneurysm of the distal middle cerebral artery: A case report. Surg Neurol Int 2022; 13:57. [PMID: 35242423 PMCID: PMC8888282 DOI: 10.25259/sni_924_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Intracranial aneurysms of the distal middle cerebral artery are rare, and most etiologies are infection or dissection. We present an extremely rare intracranial fusiform thrombosed aneurysm of the distal middle cerebral artery with histopathological confirmation of a pseudoaneurysm. Case Description: Our patient, a 68-year-old female, was previously healthy and had no history of infection or trauma. A fusiform thrombosed aneurysm of the distal middle cerebral artery was detected incidentally. The patient was treated successfully with trapping and resection of the aneurysm followed by superficial temporal artery to middle cerebral artery anastomosis. Xanthochromic and hypertrophic arachnoid membranes around the aneurysm were noticed, and a thrombus was detected inside the lesion. The aneurysmal wall had hyalinized connective tissue incompletely surrounded with intima, with no media or adventitia. Pathologically, it was a pseudoaneurysm. Conclusion: We report an extremely rare case of a pseudoaneurysm of the distal middle cerebral artery. We discuss the etiology of the lesion, with a literature review, and propose that the appearance and increase of the pseudoaneurysm was followed by microbleed of an aneurysm unrelated to the branching zone.
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Affiliation(s)
- Hodaka Kishizaki
- Department of Neurosurgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Hideki Nakajima
- Department of Neurosurgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Morio Takasaki
- Department of Neurosurgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Taku Hongo
- Department of Neurosurgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Yasuhiro Fujimoto
- Department of Neurosurgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Takaki Sakurai
- Department of Pathology, Kansai Electric Power Hospital, Osaka, Japan
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3
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Di Carlo DT, Benedetto N, Marani W, Montemurro N, Perrini P. Microvascular decompression for trigeminal neuralgia due to vertebrobasilar artery compression: a systematic review and meta-analysis. Neurosurg Rev 2021; 45:285-294. [PMID: 34309748 DOI: 10.1007/s10143-021-01606-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/18/2021] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
Trigeminal neuralgia (TN) caused by vertebrobasilar artery (VBA) compression is a rare event, reported between 2 and 6% (Linskey et al. J Neurosurg 81:1-9,1992, Vanaclocha et al.World Neurosurg 96:516-529,2016) of the time. Microvascular decompression (MVD) is advised for drug-resistant pain and, although technically challenging, is associated with an excellent outcome in current literature (Apra et al.Neurosurg Rev 40:577-582,2017, Cruccuet al. EurJ Neurol 15:1013-1028,2008, Linskey et al. J Neurosurg 81:1-9,1992). The authors performed a systematic review and meta-analysis of the literature examining the rate of MVD for trigeminal neuralgia caused by VBA compression and the post-operative outcome. The systematic search of three databases was performed for studies published between January 1990 and October 2020. Random-effects meta-analysis was used to pool the analyzed outcomes, and random-effects meta-regression was used to examine the association between the effect size and potential confounders. Funnel plot followed by Egger's linear regression was used to test publication bias. We included 9 studies, and the overall rate of TN due to VBA compression was 3.4% (95% CI 2.5-4.3%, p < 0.01, I2 = 67.9%) among all MVD for TN. Immediately after surgery, 96% (p < 0.01, I2 = 0%) of patients were pain-free, and at last follow-up, approximately 93% (p < 0.01, I2 = 0%) of patients were classified as BNI I-II. Hearing impairment and facial numbness were the most common long-term complications ensuing MVD for VBA compression (5% and 13%, respectively). In conclusion, the surgical management of trigeminal neuralgia caused by VBA compression is associated with good outcome and low rate of post-operative complications. Further studies are needed to analyze the long-term results and the rate of pain recurrence among this population.
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Affiliation(s)
- Davide Tiziano Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy.
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Nicola Benedetto
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
| | - Walter Marani
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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4
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Jiang Y, Xu F, Huang L, Lu G, Ge L, Wan H, Geng D, Zhang X. Increased Wall Enhancement Extent Representing Higher Rupture Risk of Unruptured Intracranial Aneurysms. J Korean Neurosurg Soc 2020; 64:189-197. [PMID: 33371660 PMCID: PMC7969040 DOI: 10.3340/jkns.2020.0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022] Open
Abstract
Objective This study aims to investigate the relationship between aneurysm wall enhancement and clinical rupture risks based on the magnetic resonance vessel wall imaging (MR-VWI) quantitative methods.
Methods One hundred and eight patients with 127 unruptured aneurysms were prospectively enrolled from Feburary 2016 to October 2017. Aneurysms were divided into high risk (≥10) and intermediate-low risk group (<10) according to the PHASES (Population, Hypertension, Age, Size of aneurysm, Earlier SAH history from another aneurysm, Site of aneurysm) scores. Clinical risk factors, aneurysm morphology, and wall enhancement index (WEI) calculated using 3D MR-VWI were analyzed and compared.
Results In comparison of high-risk and intermediated-low risk groups, univariate analysis showed that neck width (4.5±3.3 mm vs. 3.4±1.7 mm, p=0.002), the presence of wall enhancement (100.0% vs. 62.9%, p<0.001), and WEI (1.6±0.6 vs. 0.8±0.8, p<0.001) were significantly associated with high rupture risk. Multivariate regression analysis revealed that WEI was the most important factor in predicting high rupture risk (odds ratio, 2.6; 95% confidence interval, 1.4–4.9; p=0.002). The receiver operating characteristic (ROC) curve analysis can efficiently differentiate higher risk aneurysms (area under the curve, 0.780; p<0.001) which have a reliable WEI cutoff value (1.04; sensitivity, 0.833; specificity, 0.67) predictive of high rupture risk.
Conclusion Aneurysms with higher rupture risk based on PHASES score demonstrate increased neck width, wall enhancement, and the enhancement intensity. Higher WEI in unruptured aneurysms has a predictive value for increased rupture risk.
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Affiliation(s)
- Yeqing Jiang
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lei Huang
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Gang Lu
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Liang Ge
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Hailin Wan
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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5
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Wang J, Wei L, Lu H, Zhu Y. Roles of inflammation in the natural history of intracranial saccular aneurysms. J Neurol Sci 2020; 424:117294. [PMID: 33799211 DOI: 10.1016/j.jns.2020.117294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
Aneurysmal subarachnoid hemorrhage is caused by intracranial aneurysm (IA) rupture and results in high rates of mortality and morbidity. Factors contributing to IA generation, growth and rupture can involve genetics, injury, hemodynamics, environmental factors, and inflammation, in which inflammatory factors are believed to play central roles in the whole natural history. Inflammatory reactions that contribute to IA development may involve synthesis of many functional proteins and expression of genes induced by changes of blood flow, external stimuli such as smoking, internal balance such as hormonal status changes, and blood pressure. Meanwhile, inflammatory reactions itself can evoke inflammatory cytokines release and aggregation such as MMPs, MCP-1, TNF-α and ZO-1, directly or indirectly promoting aneurysm growth and rupture. However, the details of these inflammatory reactions and their action on inflammatory chemokines are still unknown. Moreover, some agents with the function of anti-inflammation, lipid-lowering, antihypertension or inflammatory factor inhibition may have the potential benefit to reduce the risk of aneurysm development or rupture in a group of population despite the underlying mechanism remains unclear. Consequently, we reviewed the potential inflammatory responses and their mechanisms contributing to aneurysm development and rupture and sought intervention targets that may prevent IA rupture or generation.
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Affiliation(s)
- Jienan Wang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China
| | - Haitao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China.
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6
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Maeda K, Kawano Y, Maehara N, Michiwaki Y, Nagaoka S, Uno J, Gi H, Kanemoto Y. Coiling for an unruptured saccular aneurysm at the non-branching segment of the distal anterior cerebral artery: Case report and literature review. Neuroradiol J 2020; 33:140-144. [PMID: 32019400 PMCID: PMC7140294 DOI: 10.1177/1971400920902537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Saccular aneurysms in the non-branching segment of the distal anterior cerebral artery (DACA) are extremely rare. Here, we describe the first case of coil embolization using a simple, non-adjunctive technique for an aneurysm at this rare location. CASE DESCRIPTION A 74-year-old man with an asymptomatic, unruptured aneurysm of the right DACA was followed up annually for 3 years by medical checkup. Endovascular treatment was proposed because of a slight angiographic change in the shape of the aneurysm in the past year. The aneurysm at the non-branching site of the right calloso-marginal artery was 2 mm distal to the origin, and measured 3 mm in height and 3.3 mm in width, with a neck measuring 1.7 mm wide; the calloso-marginal artery diameter was 1.6 mm. The aneurysm was successfully embolized with a simple technique using a Pre-Shaped S Microcatheter and two coils. CONCLUSIONS The simple, non-adjunctive technique for coil embolization of saccular side-wall type aneurysm in the non-branching segment of the DACA could be performed using the appropriate catheter and a softer coil.
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Affiliation(s)
- Kazushi Maeda
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Yosuke Kawano
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Naoki Maehara
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Shintaro Nagaoka
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Junji Uno
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Hidefuku Gi
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
| | - Yukihide Kanemoto
- Department of Neurosurgery,
Baba
Memorial Hospital, Sakai City, Osaka,
Japan
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7
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Signorelli F, Sela S, Gesualdo L, Chevrel S, Tollet F, Pailler-Mattei C, Tacconi L, Turjman F, Vacca A, Schul DB. Hemodynamic Stress, Inflammation, and Intracranial Aneurysm Development and Rupture: A Systematic Review. World Neurosurg 2018; 115:234-244. [DOI: 10.1016/j.wneu.2018.04.143] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
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8
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Alg VS, Ke X, Grieve J, Bonner S, Walsh DC, Bulters D, Kitchen N, Houlden H, Werring DJ. Association of functional MMP-2 gene variant with intracranial aneurysms: case-control genetic association study and meta-analysis. Br J Neurosurg 2018; 32:255-259. [PMID: 29334797 DOI: 10.1080/02688697.2018.1427213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 11/30/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Abnormalities in Matrix Metalloproteinase (MMP) genes, which are important in extracellular matrix (ECM) maintenance and therefore arterial wall integrity are a plausible underlying mechanism of intracranial aneurysm (IA) formation, growth and subsequent rupture. We investigated whether the rs243865 C > T SNP (single nucleotide polymorphism) within the MMP-2 gene (which influences gene transcription) is associated with IA compared to matched controls. MATERIALS AND METHODS We conducted a case-control genetic association study, adjusted for known IA risk factors (smoking and hypertension), in a UK Caucasian population of 1409 patients with intracranial aneurysms (IA), and 1290 matched controls, to determine the association of the rs243865 C > T functional MMP-2 gene SNP with IA (overall, and classified as ruptured and unruptured). We also undertook a meta-analysis of two previous studies examining this SNP. RESULTS The rs243865 T allele was associated with IA presence in univariate (OR 1.18 [95% CI 1.04-1.33], p = .01) and in multi-variable analyses adjusted for smoking and hypertension status (OR 1.16 [95% CI 1.01-1.35], p = .042). Subgroup analysis demonstrated an association of the rs243865 SNP with ruptured IA (OR 1.18 [95% CI 1.03-1.34] p = .017), but, not unruptured IA (OR 1.17 [95% CI 0.97-1.42], p = .11). CONCLUSIONS Our study demonstrated an association between the functional MMP-2 rs243865 variant and IAs. Our findings suggest a genetic role for altered extracellular matrix integrity in the pathogenesis of IA development and rupture.
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Affiliation(s)
- Varinder S Alg
- a Stroke Research Centre, Department of Brain Repair and Rehabilitation , Institute of Neurology, National Hospital for Neurology and Neurosurgery , London , UK
| | - Xiayi Ke
- b Institute of Child Health, Genetics & Genomic Medicine Programme , Institute of Child Health, Faculty of Pop Health Sciences, UCL , London , UK
| | - Joan Grieve
- a Stroke Research Centre, Department of Brain Repair and Rehabilitation , Institute of Neurology, National Hospital for Neurology and Neurosurgery , London , UK
| | - Stephen Bonner
- c Department of Neuroanaesthesia , James Cook University Hospital, Durham University , London , UK
| | - Daniel C Walsh
- d Department of Neurosurgery, Neurovascular Surgery , Kings College Hospital , London , UK
| | - Diederik Bulters
- e Department of Neurovascular Surgery , University Hospital Southampton , Southampton , UK
| | - Neil Kitchen
- a Stroke Research Centre, Department of Brain Repair and Rehabilitation , Institute of Neurology, National Hospital for Neurology and Neurosurgery , London , UK
| | - Henry Houlden
- a Stroke Research Centre, Department of Brain Repair and Rehabilitation , Institute of Neurology, National Hospital for Neurology and Neurosurgery , London , UK
| | - David J Werring
- a Stroke Research Centre, Department of Brain Repair and Rehabilitation , Institute of Neurology, National Hospital for Neurology and Neurosurgery , London , UK
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9
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Bekelis K, Kerley-Hamilton JS, Teegarden A, Tomlinson CR, Kuintzle R, Simmons N, Singer RJ, Roberts DW, Kellis M, Hendrix DA. MicroRNA and gene expression changes in unruptured human cerebral aneurysms. J Neurosurg 2016; 125:1390-1399. [PMID: 26918470 DOI: 10.3171/2015.11.jns151841] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The molecular mechanisms behind cerebral aneurysm formation and rupture remain poorly understood. In the past decade, microRNAs (miRNAs) have been shown to be key regulators in a host of biological processes. They are noncoding RNA molecules, approximately 21 nucleotides long, that posttranscriptionally inhibit mRNAs by attenuating protein translation and promoting mRNA degradation. The miRNA and mRNA interactions and expression levels in cerebral aneurysm tissue from human subjects were profiled. METHODS A prospective case-control study was performed on human subjects to characterize the differential expression of mRNA and miRNA in unruptured cerebral aneurysms in comparison with control tissue (healthy superficial temporal arteries [STA]). Ion Torrent was used for deep RNA sequencing. Affymetrix miRNA microarrays were used to analyze miRNA expression, whereas NanoString nCounter technology was used for validation of the identified targets. RESULTS Overall, 7 unruptured cerebral aneurysm and 10 STA specimens were collected. Several differentially expressed genes were identified in aneurysm tissue, with MMP-13 (fold change 7.21) and various collagen genes (COL1A1, COL5A1, COL5A2) being among the most upregulated. In addition, multiple miRNAs were significantly differentially expressed, with miR-21 (fold change 16.97) being the most upregulated, and miR-143-5p (fold change -11.14) being the most downregulated. From these, miR-21, miR-143, and miR-145 had several significantly anticorrelated target genes in the cohort that are associated with smooth muscle cell function, extracellular matrix remodeling, inflammation signaling, and lipid accumulation. All these processes are crucial to the pathophysiology of cerebral aneurysms. CONCLUSIONS This analysis identified differentially expressed genes and miRNAs in unruptured human cerebral aneurysms, suggesting the possibility of a role for miRNAs in aneurysm formation. Further investigation for their importance as therapeutic targets is needed.
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Affiliation(s)
| | - Joanna S Kerley-Hamilton
- Dartmouth Genomics and Microarray Laboratory, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Craig R Tomlinson
- Dartmouth Genomics and Microarray Laboratory, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Nathan Simmons
- Section of Neurosurgery and.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Robert J Singer
- Section of Neurosurgery and.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - David W Roberts
- Section of Neurosurgery and.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Manolis Kellis
- MIT Computational Biology Group and.,Computer Science and Artificial Intelligence Lab, MIT, Cambridge; and.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - David A Hendrix
- Department of Biochemistry and Biophysics and.,School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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10
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Peña-Silva RA, Chalouhi N, Wegman-Points L, Ali M, Mitchell I, Pierce GL, Chu Y, Ballas ZK, Heistad D, Hasan D. Novel role for endogenous hepatocyte growth factor in the pathogenesis of intracranial aneurysms. Hypertension 2014; 65:587-93. [PMID: 25510828 DOI: 10.1161/hypertensionaha.114.04681] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inflammation plays a key role in formation and rupture of intracranial aneurysms. Because hepatocyte growth factor (HGF) protects against vascular inflammation, we sought to assess the role of endogenous HGF in the pathogenesis of intracranial aneurysms. Circulating HGF concentrations in blood samples drawn from the lumen of human intracranial aneurysms or femoral arteries were compared in 16 patients. Tissue from superficial temporal arteries and ruptured or unruptured intracranial aneurysms collected from patients undergoing clipping (n=10) were immunostained with antibodies to HGF and its receptor c-Met. Intracranial aneurysms were induced in mice treated with PF-04217903 (a c-Met antagonist) or vehicle. Expression of inflammatory molecules was also measured in cultured human endothelial, smooth muscle cells and monocytes treated with lipopolysaccharides in presence or absence of HGF and PF-04217903. We found that HGF concentrations were significantly higher in blood collected from human intracranial aneurysms (1076±656 pg/mL) than in femoral arteries (196±436 pg/mL; P<0.001). HGF and c-Met were detected by immunostaining in superficial temporal arteries and in both ruptured and unruptured human intracranial aneurysms. A c-Met antagonist did not alter the formation of intracranial aneurysms (P>0.05), but significantly increased the prevalence of subarachnoid hemorrhage and decreased survival in mice (P<0.05). HGF attenuated expression of vascular cell adhesion molecule-1 (P<0.05) and E-Selectin (P<0.05) in human aortic endothelial cells. In conclusion, plasma HGF concentrations are elevated in intracranial aneurysms. HGF and c-Met are expressed in superficial temporal arteries and in intracranial aneurysms. HGF signaling through c-Met may decrease inflammation in endothelial cells and protect against intracranial aneurysm rupture.
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Affiliation(s)
- Ricardo A Peña-Silva
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Nohra Chalouhi
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Lauren Wegman-Points
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Muhammad Ali
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Ian Mitchell
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Gary L Pierce
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Yi Chu
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Zuhair K Ballas
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Donald Heistad
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - David Hasan
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.).
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11
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Chalouhi N, Ali MS, Starke RM, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, Koch WJ, Dumont AS. Cigarette smoke and inflammation: role in cerebral aneurysm formation and rupture. Mediators Inflamm 2012; 2012:271582. [PMID: 23316103 PMCID: PMC3532877 DOI: 10.1155/2012/271582] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 10/27/2012] [Indexed: 12/17/2022] Open
Abstract
Smoking is an established risk factor for subarachnoid hemorrhage yet the underlying mechanisms are largely unknown. Recent data has implicated a role of inflammation in the development of cerebral aneurysms. Inflammation accompanying cigarette smoke exposure may thus be a critical pathway underlying the development, progression, and rupture of cerebral aneurysms. Various constituents of the inflammatory response appear to be involved including adhesion molecules, cytokines, reactive oxygen species, leukocytes, matrix metalloproteinases, and vascular smooth muscle cells. Characterization of the molecular basis of the inflammatory response accompanying cigarette smoke exposure will provide a rational approach for future targeted therapy. In this paper, we review the current body of knowledge implicating cigarette smoke-induced inflammation in cerebral aneurysm formation/rupture and attempt to highlight important avenues for future investigation.
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Affiliation(s)
- Nohra Chalouhi
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Muhammad S. Ali
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Robert M. Starke
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Pascal M. Jabbour
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Stavropoula I. Tjoumakaris
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - L. Fernando Gonzalez
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Robert H. Rosenwasser
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Walter J. Koch
- Center for Translational Medicine and George Zallie and Family Laboratory for Cardiovascular Gene Therapy, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aaron S. Dumont
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
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12
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Gorny O, Drach M, Falkensammer J, Posch L, Fraedrich G. Segmental disruption of the internal elastic lamina as a potential pathogenetic mechanism of a true posttraumatic femoral artery aneurysm, years after single blunt trauma. Ann Vasc Surg 2012; 27:111.e11-4. [PMID: 23084426 DOI: 10.1016/j.avsg.2012.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 10/04/2011] [Accepted: 05/07/2012] [Indexed: 11/25/2022]
Abstract
We present an unusual case of a true posttraumatic aneurysm of the superficial femoral artery (SFAA) 7 years after a motorcycle accident including blunt trauma to the thigh. Surgical reconstruction was accomplished without any complications by aneurysm resection and interposition of an autologous reversed saphenous vein. Histopathological examination revealed a true aneurysm with segmental disruption and fragmentation of the internal elastic lamina (IEL) in van Gieson's stain. This is a first-time finding in context with SFAA and may represent the pathogenetic explanation for the rare formation of posttraumatic true aneurysms.
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Affiliation(s)
- Olaf Gorny
- Department of Vascular Surgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Austria.
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13
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Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, Koch WJ, Dumont AS. Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab 2012; 32:1659-76. [PMID: 22781330 PMCID: PMC3434628 DOI: 10.1038/jcbfm.2012.84] [Citation(s) in RCA: 361] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intracranial aneurysms (IAs) linger as a potentially devastating clinical problem. Despite intense investigation, our understanding of the mechanisms leading to aneurysm development, progression and rupture remain incompletely defined. An accumulating body of evidence implicates inflammation as a critical contributor to aneurysm pathogenesis. Intracranial aneurysm formation and progression appear to result from endothelial dysfunction, a mounting inflammatory response, and vascular smooth muscle cell phenotypic modulation producing a pro-inflammatory phenotype. A later final common pathway appears to involve apoptosis of cellular constituents of the vessel wall. These changes result in degradation of the integrity of the vascular wall leading to aneurysmal dilation, progression and eventual rupture in certain aneurysms. Various aspects of the inflammatory response have been investigated as contributors to IA pathogenesis including leukocytes, complement, immunoglobulins, cytokines, and other humoral mediators. Furthermore, gene expression profiling of IA compared with control arteries has prominently featured differential expression of genes involved with immune response/inflammation. Preliminary data suggest that therapies targeting the inflammatory response may have efficacy in the future treatment of IA. Further investigation, however, is necessary to elucidate the precise role of inflammation in IA pathogenesis, which can be exploited to improve the prognosis of patients harboring IA.
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Affiliation(s)
- Nohra Chalouhi
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
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14
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Umeoka K, Shirokane K, Mizunari T, Kobayashi S, Teramoto A. Dissecting aneurysm of the anterior temporal artery: case report. Neurol Med Chir (Tokyo) 2012; 51:777-80. [PMID: 22123481 DOI: 10.2176/nmc.51.777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 65-year-old woman presented a rare dissecting aneurysm of the anterior temporal artery (ATA) manifesting as headache. Computed tomography and magnetic resonance imaging revealed a mixed-density mass in the horizontal segment of the middle cerebral artery. Emergent angiography demonstrated aneurysmal dilatation and a thrombosed mass in the sylvian fissure. Infectious aneurysm was excluded. She underwent emergent surgery to reduce the risk of repeated infarction and hemorrhage. The distal side of the ATA manifested occlusive changes suggestive of arterial dissection. The proximal side of the ATA was ligated and the lesion was excised. Histological examination confirmed that the aneurysmal dilatation was attributable to arterial dissection due to disruption of the internal elastic lamina. Distal dissecting aneurysms may occur in the absence of infectious disease. We recommend that ruptured distal dissecting aneurysms be treated surgically in the acute stage immediately after detection.
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Affiliation(s)
- Katsuya Umeoka
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba.
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15
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Defillo A, Nussbaum ES, Zelensky A, Nussbaum L. Multiple non-branching dissecting aneurysms of the mid-basilar trunk presenting with sequential subarachnoid hemorrhages. Surg Neurol Int 2011; 2:127. [PMID: 22059122 PMCID: PMC3205486 DOI: 10.4103/2152-7806.85059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/22/2011] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We describe a rare case of a patient with subarachnoid hemorrhage (SAH) due to a ventral dissecting mid-basilar aneurysm that was treated surgically. One week after surgery, the patient experienced sudden deterioration due to a new SAH caused by the development of a new aneurysm of the basilar trunk distinct from the previously clipped aneurysm. CASE DESCRIPTION A 54-year-old woman with acute subarachnoid hemorrhage was found to have a small, broad-based aneurysm arising from the ventral aspect of the mid-basilar artery. This complicated lesion was treated with a microsurgical clipping via a translabyrinthine pre-sigmoidal sub-temporal approach. One week postoperatively, the patient suffered a new SAH and was found to have developed a distinct basilar artery aneurysm. The patient was returned to the Operating Room for microsurgical clipping via the previous craniotomy. After surgery, the patient made a slow, but steady, recovery. She underwent repeated angiographic imaging, demonstrating a stable appearance. Two years post surgery, the patient had returned to work and had no obvious neurological deficit, with the exception of unilateral iatrogenic hearing loss. CONCLUSION We describe a rare case of multiple aneurysms originating in relation to a mid-basilar dissection, resulting in multiple episodes of SAH. These are difficult and dangerous lesions that can be treated with open microsurgical reconstruction or possibly via an endovascular approach. The intricate location of the lesions poses a particular challenge to neurosurgeons attempting to directly treat mid-basilar lesions.
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Affiliation(s)
- Archie Defillo
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
| | - Eric S. Nussbaum
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
| | - Andrea Zelensky
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
| | - Leslie Nussbaum
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
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16
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Sakata N, Minematsu N, Morishige N, Tashiro T, Imanaga Y. Histopathologic Characteristics of a Coronary-pulmonary Artery Fistula with a Coronary Artery Aneurysm. Ann Vasc Dis 2011; 4:43-6. [PMID: 23555427 DOI: 10.3400/avd.cr.10.00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/20/2010] [Indexed: 11/13/2022] Open
Abstract
Here, we report a case of a 59-year-old woman with a coronary-pulmonary artery fistula with a concomitant coronary artery aneurysm, which comprised an anomalous coronary artery originating at the right coronary cusp, an aberrant branch of the left anterior descending artery, and a coronary artery aneurysm draining into the main pulmonary artery. Histopathologically, non-dilated anomalous coronary artery showed the preservation of internal elastic lamina and medial smooth muscle cell phenotype which lacked in the aneurysmal wall. Thus, the disrupted internal elastic lamina and phenotypic change of medial smooth muscle cells might contribute to aneurysm formation in a coronary-pulmonary arterial fistula.
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Affiliation(s)
- Noriyuki Sakata
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
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17
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Bygglin H, Laaksamo E, Myllärniemi M, Tulamo R, Hernesniemi J, Niemelä M, Laakso A. Isolation, culture, and characterization of smooth muscle cells from human intracranial aneurysms. Acta Neurochir (Wien) 2011; 153:311-8. [PMID: 20936486 DOI: 10.1007/s00701-010-0836-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 09/30/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Smooth muscle cells (SMCs) play a critical role in the vascular wall and also participate in vascular repair mechanisms. Dysfunction of SMCs may also contribute to the formation of intracranial aneurysms (IAs) causing subarachnoid hemorrhage. Our aim was to investigate the possibility of using cultured SMCs as an in vitro model for the study of aneurysmal SMCs. METHODS IA tissue was obtained during microsurgical ligation of IAs. By using the explant method, cell cultures were established from the aneurysmal tissue. The phenotype of cultured cells from passage to passage was studied using immunoperoxidase staining and Western blotting. Eight cell lines could be established from 29 IA samples. Four lines showing most rigorous growth were investigated more thoroughly. RESULTS Abundant expression of SMC markers, α-smooth muscle cell actin and calponin, as well as of prolyl-4-hydroxylases, a key enzyme family in the synthesis of collagens, was observed in all of them. Aneurysmal SMCs in culture maintained their phenotype and SMC characteristics through the early passages of growth. CONCLUSION This is the first documented successful culture of SMCs from human IAs. An access to living human cells of aneurysmal origin gives us a new tool in our research of the formation, growth, and rupture of IAs.
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