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Kronborg TM, Schierwagen R, Trošt K, Gao Q, Moritz T, Bendtsen F, Gantzel RH, Andersen ML, Teisner AS, Grønbæk H, Hobolth L, Møller S, Trebicka J, Kimer N. Atorvastatin for patients with cirrhosis. A randomized, placebo-controlled trial. Hepatol Commun 2023; 7:e0332. [PMID: 38051553 PMCID: PMC10697620 DOI: 10.1097/hc9.0000000000000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with cirrhosis and portal hypertension face a high risk of complications. Besides their anti-inflammatory and antifibrotic effects, statins may reduce portal pressure and thus the risk of complications and mortality. We aimed to investigate the effects of atorvastatin on hospital admissions, mortality, inflammation, and lipidomics in cirrhosis with portal hypertension. METHODS We performed a double-blinded, randomized, placebo-controlled clinical trial among patients with cirrhosis and portal hypertension. Atorvastatin (10-20 mg/d) was administered for 6 months. We measured splanchnic hemodynamics, analyzed inflammatory markers, and performed lipidomics at baseline and after 6 months. RESULTS Seventy-eight patients were randomized, with 38 patients allocated to atorvastatin and 40 patients to placebo. Fifty-nine patients completed 6 months of intervention. Comparisons between changes in each group were calculated. Liver-related complications and mortality were similar between the groups. The HVPG and Model for End-stage Liver Disease score did not change between groups (p=0.95 and 0.87, respectively). Atorvastatin decreased 3 of 42 inflammatory markers, CD62-L-selectin, matrix metalloproteinases-2, and TNF-α (p-values: 0.005, 0.011, and 0.023, respectively), while lipidomics was not significantly changed. CONCLUSIONS In patients with cirrhosis, atorvastatin was safe to use, but did not reduce mortality, the risk of liver-related complications, or the HVPG. Atorvastatin induced minor anti-inflammatory effects and minor effects on lipids during a 6-month treatment period.
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Affiliation(s)
- Thit M. Kronborg
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Robert Schierwagen
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Kajetan Trošt
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Qian Gao
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Moritz
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus H. Gantzel
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Mette L. Andersen
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital, Herlev, Denmark
| | - Ane S. Teisner
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital, Herlev, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Lise Hobolth
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Centre of Functional Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jonel Trebicka
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
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2
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Wach J, Vychopen M, Güresir A, Güresir E. Anti-Inflammatory Drug Therapy in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Prospective Randomized and Placebo-Controlled Trials. J Clin Med 2023; 12:4165. [PMID: 37373858 DOI: 10.3390/jcm12124165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
Emerging evidence suggests that neuroinflammation may play a potential role in aneurysmal subarachnoid hemorrhage (aSAH). We aim to analyze the influence of anti-inflammatory therapy on survival and outcome in aSAH. Eligible randomized placebo-controlled prospective trials (RCTs) were searched in PubMed until March 2023. After screening the available studies for inclusion and exclusion criteria, we strictly extracted the main outcome measures. Dichotomous data were determined and extracted by odds ratio (OR) with 95% confidence intervals (CIs). Neurological outcome was graded using the modified Rankin Scale (mRS). We created funnel plots to analyze publication bias. From 967 articles identified during the initial screening, we included 14 RCTs in our meta-analysis. Our results illustrate that anti-inflammatory therapy yields an equivalent probability of survival compared to placebo or conventional management (OR: 0.81, 95% CI: 0.55-1.19, p = 0.28). Generally, anti-inflammatory therapy trended to be associated with a better neurologic outcome (mRS ≤ 2) compared to placebo or conventional treatment (OR: 1.48, 95% CI: 0.95-2.32, p = 0.08). Our meta-analysis showed no increased mortality form anti-inflammatory therapy. Anti-inflammatory therapy in aSAH patients tends to improve the neurological outcome. However, multicenter, rigorous, designed, prospective randomized studies are still needed to investigate the effect of fighting inflammation in improving neurological functioning after aSAH.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Martin Vychopen
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Agi Güresir
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
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3
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Miao SH, Gao SQ, Li HX, Zhuang YS, Wang X, Li T, Gao CC, Han YL, Qiu JY, Zhou ML. Increased NOX2 expression in astrocytes leads to eNOS uncoupling through dihydrofolate reductase in endothelial cells after subarachnoid hemorrhage. Front Mol Neurosci 2023; 16:1121944. [PMID: 37063365 PMCID: PMC10097896 DOI: 10.3389/fnmol.2023.1121944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionEndothelial nitric oxide synthase (eNOS) uncoupling plays a significant role in acute vasoconstriction during early brain injury (EBI) after subarachnoid hemorrhage (SAH). Astrocytes in the neurovascular unit extend their foot processes around endothelia. In our study, we tested the hypothesis that increased nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2) expression in astrocytes after SAH leads to eNOS uncoupling.MethodsWe utilized laser speckle contrast imaging for monitoring cortical blood flow changes in mice, nitric oxide (NO) kits to measure the level of NO, and a co-culture system to study the effect of astrocytes on endothelial cells. Moreover, the protein levels were assessed by Western blot and immunofluorescence staining. We used CCK-8 to measure the viability of astrocytes and endothelial cells, and we used the H2O2 kit to measure the H2O2 released from astrocytes. We used GSK2795039 as an inhibitor of NOX2, whereas lentivirus and adeno-associated virus were used for dihydrofolate reductase (DHFR) knockdown in vivo and in vitro.ResultsThe expression of NOX2 and the release of H2O2 in astrocytes are increased, which was accompanied by a decrease in endothelial DHFR 12 h after SAH. Moreover, the eNOS monomer/dimer ratio increased, leading to a decrease in NO and acute cerebral ischemia. All of the above were significantly alleviated after the administration of GSK2795039. However, after knocking down DHFR both in vivo and in vitro, the protective effect of GSK2795039 was greatly reversed.DiscussionThe increased level of NOX2 in astrocytes contributes to decreased DHFR in endothelial cells, thus aggravating eNOS uncoupling, which is an essential mechanism underlying acute vasoconstriction after SAH.
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Affiliation(s)
- Shu-Hao Miao
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Sheng-Qing Gao
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hui-Xin Li
- Department of Gynecology, Women’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Song Zhuang
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Xue Wang
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tao Li
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Chao-Chao Gao
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yan-Ling Han
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jia-Yin Qiu
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Meng-Liang Zhou
- Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
- *Correspondence: Meng-Liang Zhou,
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Lu T, He Y, Liu Z, Ma C, Chen S, Jia R, Duan L, Guo C, Liu Y, Guo D, Li T, He Y. A machine learning-derived gene signature for assessing rupture risk and circulatory immunopathologic landscape in patients with intracranial aneurysms. Front Cardiovasc Med 2023; 10:1075584. [PMID: 36844725 PMCID: PMC9950511 DOI: 10.3389/fcvm.2023.1075584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Background Intracranial aneurysm (IA) is an uncommon but severe subtype of cerebrovascular disease, with high mortality after aneurysm rupture. Current risk assessments are mainly based on clinical and imaging data. This study aimed to develop a molecular assay tool for optimizing the IA risk monitoring system. Methods Peripheral blood gene expression datasets obtained from the Gene Expression Omnibus were integrated into a discovery cohort. Weighted gene co-expression network analysis (WGCNA) and machine learning integrative approaches were utilized to construct a risk signature. QRT-PCR assay was performed to validate the model in an in-house cohort. Immunopathological features were estimated using bioinformatics methods. Results A four-gene machine learning-derived gene signature (MLDGS) was constructed for identifying patients with IA rupture. The AUC of MLDGS was 1.00 and 0.88 in discovery and validation cohorts, respectively. Calibration curve and decision curve analysis also confirmed the good performance of the MLDGS model. MLDGS was remarkably correlated with the circulating immunopathologic landscape. Higher MLDGS scores may represent higher abundance of innate immune cells, lower abundance of adaptive immune cells, and worse vascular stability. Conclusions The MLDGS provides a promising molecular assay panel for identifying patients with adverse immunopathological features and high risk of aneurysm rupture, contributing to advances in IA precision medicine.
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Affiliation(s)
- Taoyuan Lu
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Yanyan He
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Zaoqu Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chi Ma
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Song Chen
- Translational Research Institute, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Rufeng Jia
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Lin Duan
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Chunguang Guo
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yiying Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dehua Guo
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China,Tianxiao Li,
| | - Yingkun He
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China,Henan International Joint Laboratory of Cerebrovascular Disease, Henan Provincial NeuroInterventional Engineering Research Center, Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China,*Correspondence: Yingkun He,
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Weyer V, Maros ME, Kirschner S, Krost-Reuhl S, Groden C, Kramer M, Brockmann MA, Kronfeld A. Influence of neurovascular anatomy on perforation site in different mouse strains using the filament perforation model for induction of subarachnoid hemorrhage. PLoS One 2022; 17:e0263983. [PMID: 36227879 PMCID: PMC9560502 DOI: 10.1371/journal.pone.0263983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Filament perforation is a widely-used method to induce subarachnoid hemorrhage (SAH) in mice. Whereas the perforation site has been assumed to be in the branching of middle cerebral artery (MCA) and anterior cerebral artery (ACA), we recently observed more proximal perforations. METHODS Filament perforation was performed in CD1- (n = 10) and C57Bl/6N-mice (n = 9) ex vivo. The filament was left in place and the perforation site was microscopically assessed. Digital subtraction angiography (DSA) was performed in CD1- (n = 9) and C57Bl/6J-mice (n = 29) and anatomical differences of the internal carotid artery (ICA) were determined. RESULTS Whereas in C57Bl/6N-mice perforation occurred in the proximal intracranial ICA in 89% (n = 8), in CD1-mice the perforation site was in the proximal ICA in 50% (n = 5), in the branching between MCA and ACA in 40% (n = 4), and in the proximal ACA in 10% (n = 1). DSA revealed a stronger angulation (p<0.001) of the ICA in CD1-mice (163.5±2.81°) compared to C57Bl/6J-mice (124.5±5.49°). Body weight and ICA-angle showed no significant correlation in C57Bl/6J- (r = -0.06, pweight/angle = 0.757) and CD1-mice (r = -0.468, pweight/angle = 0.242). CONCLUSION Filament perforation in mice occurs not only at the hitherto presumed branching between MCA and ACA, but seems to depend on mouse strain and anatomy as the proximal intracranial ICA may also be perforated frequently.
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Affiliation(s)
- Vanessa Weyer
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
- Medical Faculty Mannheim, Department of Neuroradiology, University of Heidelberg, Mannheim, Germany
- Medical Faculty Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - Máté E. Maros
- Medical Faculty Mannheim, Department of Neuroradiology, University of Heidelberg, Mannheim, Germany
| | - Stefanie Kirschner
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
- Medical Faculty Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | | | - Christoph Groden
- Medical Faculty Mannheim, Department of Neuroradiology, University of Heidelberg, Mannheim, Germany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marc A. Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
- * E-mail:
| | - Andrea Kronfeld
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
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Bershad EM, Suarez JI. Aneurysmal Subarachnoid Hemorrhage. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Trigiani LJ, Bourourou M, Lacalle-Aurioles M, Lecrux C, Hynes A, Spring S, Fernandes DJ, Sled JG, Lesage F, Schwaninger M, Hamel E. A functional cerebral endothelium is necessary to protect against cognitive decline. J Cereb Blood Flow Metab 2022; 42:74-89. [PMID: 34515549 PMCID: PMC8721775 DOI: 10.1177/0271678x211045438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A vascular insult occurring early in disease onset may initiate cognitive decline leading to dementia, while pharmacological and lifestyle interventions can prevent this progression. Mice with a selective, tamoxifen-inducible deletion of NF-κB essential modulator (Nemo) in brain endothelial cells were studied as a model of vascular cognitive impairment. Groups included NemoFl controls and three NemobeKO groups: One untreated, and two treated with simvastatin or exercise. Social preference and nesting were impaired in NemobeKO mice and were not countered by treatments. Cerebrovascular function was compromised in NemobeKO groups regardless of treatment, with decreased changes in sensory-evoked cerebral blood flow and total hemoglobin levels, and impaired endothelium-dependent vasodilation. NemobeKO mice had increased string vessel pathology, blood-brain barrier disruption, neuroinflammation, and reduced cortical somatostatin-containing interneurons. These alterations were reversed when endothelial function was recovered. Findings strongly suggest that damage to the cerebral endothelium can trigger pathologies associated with dementia and its functional integrity should be an effective target in future therapeutic efforts.
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Affiliation(s)
- Lianne J Trigiani
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Canada
| | - Miled Bourourou
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Canada
| | - María Lacalle-Aurioles
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Canada
| | - Clotilde Lecrux
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Canada
| | - Amy Hynes
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Canada
| | - Shoshana Spring
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, Canada
| | - Darren J Fernandes
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, Canada
| | - John G Sled
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, Canada
| | - Frédéric Lesage
- Biomedical Engineering Institute, École Polytechnique de Montréal, Montréal, Canada
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | - Edith Hamel
- Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Canada
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Liu T, Zhong S, Zhai Q, Zhang X, Jing H, Li K, Liu S, Han S, Li L, Shi X, Bao Y. Optimal Course of Statins for Patients With Aneurysmal Subarachnoid Hemorrhage: Is Longer Treatment Better? A Meta-Analysis of Randomized Controlled Trials. Front Neurosci 2021; 15:757505. [PMID: 34759796 PMCID: PMC8573116 DOI: 10.3389/fnins.2021.757505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Statins are used in clinical practice to prevent from complications such as cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH). However, the efficacy and safety of statins are still controversial due to insufficient evidence from randomized controlled trials and inconsistent results of the existing studies. This meta-analysis aimed to systematically review the latest evidence on the time window and complications of statins in aSAH. The randomized controlled trials in the databases of The Cochrane Library, PubMed, Web of Science, Embase, CNKI, and Wanfang from January 2005 to April 2021 were searched and analyzed systematically. Data analysis was performed using Stata version 16.0. The fixed-effects model (M-H method) with effect size risk ratio (RR) was used for subgroups with homogeneity, and the random-effects model (D-L method) with effect size odds ratio (OR) was used for subgroups with heterogeneity. The primary outcomes were poor neurological prognosis and all-cause mortality, and the secondary outcomes were cerebral vasospasm (CVS) and statin-related complications. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021247376). Nine studies comprising 1,464 patients were included. The Jadad score of the patients was 5–7. Meta-analysis showed that poor neurological prognosis was reduced in patients who took oral statins for 14 days (RR, 0.73 [0.55–0.97]; I2 = 0%). Surprisingly, the continuous use of statins for 21 days had no significant effect on neurological prognosis (RR, 1.04 [0.89–1.23]; I2 = 17%). Statins reduced CVS (OR, 0.51 [0.36–0.71]; I2 = 0%) but increased bacteremia (OR, 1.38 [1.01–1.89]; I2 = 0%). In conclusion, a short treatment course of statins over 2 weeks may improve neurological prognosis. Statins were associated with reduced CVS. Based on the pathophysiological characteristics of CVS and the evaluation of prognosis, 2 weeks could be the optimal time window for statin treatment in aSAH, although bacteremia may increase.
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Affiliation(s)
- Tao Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Shiyu Zhong
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Qingqing Zhai
- School of Management, Shanghai University, Shanghai, China
| | - Xudong Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Huiquan Jing
- School of Public Health, Capital Medical University, Beijing, China
| | - Kunhang Li
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengyu Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Shuo Han
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lishuai Li
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin Shi
- School of Maths and Information Science, Shandong Institute of Business and Technology, Yantai, China.,Business School, Manchester Metropolitan University, Manchester, United Kingdom
| | - Yijun Bao
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Alabed M, Elemam NM, Ramakrishnan RK, Sharif-Askari NS, Kashour T, Hamid Q, Halwani R. Therapeutic effect of statins on airway remodeling during asthma. Expert Rev Respir Med 2021; 16:17-24. [PMID: 34663161 DOI: 10.1080/17476348.2021.1987890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Asthma is a chronic inflammatory disease of the airways, which is usually characterized by remodeling, hyperresponsiveness and episodic obstruction of the airways. The underlying chronic airway inflammation leads to pathological restructuring of both the large and small airways. Since the effects of current asthma medications on airway remodeling have been met with contradictions, many therapeutic agents have been redirected from their primary use for the treatment of asthma. Such treatments, which could target several signaling molecules implicated in the inflammatory and airway remodeling processes of asthma, would be an ideal choice. AREAS COVERED Statins are effective serum cholesterol-lowering agents that were found to have potential anti-inflammatory and anti-remodeling properties. Literature search was done for the past 10 years to include research and review articles in the field of statins and asthma complications. In this review, we discuss the role of statins in airway tissue remodeling and their potential therapeutic modalities in asthma. EXPERT OPINION With improved understanding of the role of statins in airway remodeling and inflammation, statins represent a potential therapeutic option for various asthma phenotypes. Further research is warranted to optimize statins for asthma therapy through inhalation as a possible route of administration.
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Affiliation(s)
- Mashael Alabed
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha Mousaad Elemam
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rakhee K Ramakrishnan
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Narjes Saheb Sharif-Askari
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Tarek Kashour
- Department of Cardiology, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Qutayba Hamid
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Meakins-Christie Laboratories, Research Institute of the McGill University Healthy Center, McGill University, Montreal, Quebec, Canada.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rabih Halwani
- Sharjah Institute of Medical Research, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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10
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Yan Z, Wu Q, Cai W, Xiang H, Wen L, Zhang A, Peng Y, Zhang X, Wang H. Identifying critical genes associated with aneurysmal subarachnoid hemorrhage by weighted gene co-expression network analysis. Aging (Albany NY) 2021; 13:22345-22360. [PMID: 34542421 PMCID: PMC8507255 DOI: 10.18632/aging.203542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening medical condition with a high mortality and disability rate. aSAH has an unclear pathogenesis, and limited treatment options are available. Here, we aimed to identify critical genes involved in aSAH pathogenesis using peripheral blood gene expression data of 43 patients with aSAH due to ruptured intracranial aneurysms and 18 controls with headache, downloaded from Gene Expression Omnibus. These data were used to construct a co-expression network using weighted gene co-expression network analysis (WGCNA). The biological functions of the hub genes were explored, and critical genes were selected by combining with differentially expressed genes analysis. Fourteen modules were identified by WGCNA. Among those modules, red, blue, brown and cyan modules were closely associated with aSAH. Moreover, 364 hub genes in the significant modules were found to play important roles in aSAH. Biological function analysis suggested that protein biosynthesis-related processes and inflammatory responses-related processes were involved in the pathology of aSAH pathology. Combined with differentially expressed genes analysis and validation in 35 clinical samples, seven gene (CD27, ANXA3, ACSL1, PGLYRP1, ALPL, ARG1, and TPST1) were identified as potential biomarkers for aSAH, and three genes (ANXA3, ALPL, and ARG1) were changed with disease development, that may provide new insights into potential molecular mechanisms for aSAH.
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Affiliation(s)
- Zhizhong Yan
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.,Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China.,Department of Neurosurgery, The 904th Hospital of The Joint Logistics Support Force of Chinese People's Liberation Army, Wuxi 214000, China
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China
| | - Wei Cai
- Department of Neurosurgery, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian 223800, China
| | - Haitao Xiang
- Department of Neurosurgery, Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, China
| | - Lili Wen
- Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China
| | - An Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China
| | - Yaonan Peng
- Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China
| | - Handong Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China.,Department of Neurosurgery, Jinling Hospital, Nanjing 210002, China
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11
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Lenz IJ, Plesnila N, Terpolilli NA. Role of endothelial nitric oxide synthase for early brain injury after subarachnoid hemorrhage in mice. J Cereb Blood Flow Metab 2021; 41:1669-1681. [PMID: 33256507 PMCID: PMC8221759 DOI: 10.1177/0271678x20973787] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The first few hours and days after subarachnoid hemorrhage (SAH) are characterized by cerebral ischemia, spasms of pial arterioles, and a significant reduction of cerebral microperfusion, however, the mechanisms of this early microcirculatory dysfunction are still unknown. Endothelial nitric oxide production is reduced after SAH and exogenous application of NO reduces post-hemorrhagic microvasospasm. Therefore, we hypothesize that the endothelial NO-synthase (eNOS) may be involved in the formation of microvasospasms, microcirculatory dysfunction, and unfavorable outcome after SAH. SAH was induced in male eNOS deficient (eNOS-/-) mice by endovascular MCA perforation. Three hours later, the cerebral microcirculation was visualized using in vivo 2-photon-microscopy. eNOS-/- mice had more severe SAHs, more severe ischemia, three time more rebleedings, and a massively increased mortality (50 vs. 0%) as compared to wild type (WT) littermate controls. Three hours after SAH eNOS-/- mice had fewer perfused microvessels and 40% more microvasospasms than WT mice. The current study indicates that a proper function of eNOS plays a key role for a favorable outcome after SAH and helps to explain why patients suffering from hypertension or other conditions associated with impaired eNOS function, have a higher risk of unfavorable outcome after SAH.
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Affiliation(s)
- Irina J Lenz
- Institute for Stroke- and Dementia Research (ISD), Munich University Hospital and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Nikolaus Plesnila
- Institute for Stroke- and Dementia Research (ISD), Munich University Hospital and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Nicole A Terpolilli
- Institute for Stroke- and Dementia Research (ISD), Munich University Hospital and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Department of Neurosurgery, Munich University Hospital, Munich, Germany
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12
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Kashefiolasl S, Wagner M, Brawanski N, Seifert V, Wanderer S, Andereggen L, Konczalla J. Statins Improve Clinical Outcome After Non-aneurysmal Subarachnoid Hemorrhage: A Translational Insight From a Systematic Review of Experimental Studies. Front Neurol 2021; 12:620096. [PMID: 34054685 PMCID: PMC8160298 DOI: 10.3389/fneur.2021.620096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
The efficacy of statin-treatment in aneurysmal subarachnoid hemorrhage (SAH) remains controversial. We aimed to investigate the effects of statin-treatment in non-aneurysmal (na)SAH in accordance with animal research data illustrating the pathophysiology of naSAH. We systematically searched PubMed using PRISMA-guidelines and selected experimental studies assessing the statin-effect on SAH. Detecting the accordance of the applied experimental models with the pathophysiology of naSAH, we analyzed our institutional database of naSAH patients between 1999 and 2018, regarding the effect of statin treatment in these patients and creating a translational concept. Patient characteristics such as statin-treatment (simvastatin 40 mg/d), the occurrence of cerebral vasospasm (CVS), delayed infarction (DI), delayed cerebral ischemia (DCI), and clinical outcome were recorded. In our systematic review of experimental studies, we found 13 studies among 18 titles using blood-injection-animal-models to assess the statin-effect in accordance with the pathophysiology of naSAH. All selected studies differ on study-setting concerning drug-administration, evaluation methods, and neurological tests. Patients from the Back to Bedside project, including 293 naSAH-patients and 51 patients with simvastatin-treatment, were recruited for this analysis. Patients under treatment were affected by a significantly lower risk of CVS (p < 0.01; OR 3.7), DI (p < 0.05; OR 2.6), and DCI (p < 0.05; OR 3). Furthermore, there was a significant association between simvastatin-treatment and favorable-outcome (p < 0.05; OR 3). However, dividing patients with statin-treatment in pre-SAH (n = 31) and post-SAH (n = 20) treatment groups, we only detected a tenuously significant higher chance for a favorable outcome (p < 0.05; OR 0.05) in the small group of 20 patients with statin post-SAH treatment. Using a multivariate-analysis, we detected female gender (55%; p < 0.001; OR 4.9), Hunt&Hess ≤III at admission (p < 0.002; OR 4), no anticoagulant-therapy (p < 0.0001; OR 0.16), and statin-treatment (p < 0.0001; OR 24.2) as the main factors improving the clinical outcome. In conclusion, we detected a significantly lower risk for CVS, DCI, and DI in naSAH patients under statin treatment. Additionally, a significant association between statin treatment and favorable outcome 6 months after naSAH onset could be confirmed. Nevertheless, unified animal experiments should be considered to create the basis for developing new therapeutic schemes.
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Affiliation(s)
- Sepide Kashefiolasl
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nina Brawanski
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Juergen Konczalla
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany
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13
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Lucke-Wold B, Hosaka K, Dodd W, Motwani K, Laurent D, Martinez M, Hoh B. Interleukin-6: Important Mediator of Vasospasm Following Subarachnoid Hemorrhage. Curr Neurovasc Res 2021; 18:364-369. [PMID: 34736380 PMCID: PMC10127255 DOI: 10.2174/1567202618666211104122408] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 02/08/2023]
Abstract
The correlation of neuroinflammation with the development of cerebral vasospasm following subarachnoid hemorrhage has been well documented in the literature; both clinical and preclinical. The exact mechanisms by which this process occurs, however, are poorly elucidated. Recent evidence indicates that interleukin-6 is not only an important prognostic biomarker for subarachnoid hemorrhage and subsequent vasospasm development but also an integral component in the progression of injury following initial insult. In this review, we briefly highlight other pathways under investigation and focus heavily on what has been discovered regarding the role of interleukin 6 and cerebral vasospasm following subarachnoid hemorrhage. A proposed mechanistic pathway is highlighted in written and graphical format. A discussion regarding the human correlative findings and initial pre-clinical mechanistic studies is addressed. Finally, in the future investigation section, innovative developments and a clear description of areas warranting further scientific inquiry are emphasized. This review will catalyze continued discovery in this area of emerging significance and aid in the quest for effective vasospasm treatment where limited clinical therapeutics currently exist.
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Affiliation(s)
- Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Koji Hosaka
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - William Dodd
- College of Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Kartik Motwani
- College of Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Melanie Martinez
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Brian Hoh
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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14
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Chen S, Xu P, Fang Y, Lenahan C. The Updated Role of the Blood Brain Barrier in Subarachnoid Hemorrhage: From Basic and Clinical Studies. Curr Neuropharmacol 2020; 18:1266-1278. [PMID: 32928088 PMCID: PMC7770644 DOI: 10.2174/1570159x18666200914161231] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke associated with high mortality and morbidity. The blood-brain-barrier (BBB) is a structure consisting primarily of cerebral microvascular endothelial cells, end feet of astrocytes, extracellular matrix, and pericytes. Post-SAH pathophysiology included early brain injury and delayed cerebral ischemia. BBB disruption was a critical mechanism of early brain injury and was associated with other pathophysiological events. These pathophysiological events may propel the development of secondary brain injury, known as delayed cerebral ischemia. Imaging advancements to measure BBB after SAH primarily focused on exploring innovative methods to predict clinical outcome, delayed cerebral ischemia, and delayed infarction related to delayed cerebral ischemia in acute periods. These predictions are based on detecting abnormal changes in BBB permeability. The parameters of BBB permeability are described by changes in computed tomography (CT) perfusion and magnetic resonance imaging (MRI). Kep seems to be a stable and sensitive indicator in CT perfusion, whereas Ktrans is a reliable parameter for dynamic contrast-enhanced MRI. Future prediction models that utilize both the volume of BBB disruption and stable parameters of BBB may be a promising direction to develop practical clinical tools. These tools could provide greater accuracy in predicting clinical outcome and risk of deterioration. Therapeutic interventional exploration targeting BBB disruption is also promising, considering the extended duration of post-SAH BBB disruption.
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Affiliation(s)
- Sheng Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou,
Zhejiang Province, China
| | - PengLei Xu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou,
Zhejiang Province, China
| | - YuanJian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou,
Zhejiang Province, China
| | - Cameron Lenahan
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA,Center for Neuroscience Research, School of Medicine, Loma Linda University, Loma Linda, CA, USA
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15
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Nanegrungsunk D, Ragozzino ME, Xu HL, Haselton KJ, Paisansathan C. Subarachnoid hemorrhage in C57BL/6J mice increases motor stereotypies and compulsive-like behaviors. Neurol Res 2020; 43:239-251. [PMID: 33135605 DOI: 10.1080/01616412.2020.1841481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Long-term behavioral, mood, and cognitive deficits affect over 30% of patients with subarachnoid hemorrhage (SAH). The aim of the present study was to examine the neurobehavioral outcomes following endovascular perforation induced SAH in mice. METHODS C57BL/6 J (B6) mice were exposed to endovascular perforation induced SAH or control surgery. Three weeks later, mice received a series of behavioral tests, e.g. motor function, stereotypy, learning, memory, behavioral flexibility, depression and anxiety. The immunohistologic experiment examined neuronalloss in the cortex following SAH. RESULTS SAH mice exhibited increased marble burying and nestlet shredding compared to that of control mice. Although SAH did not affect memory, learning or reversal learning,mice displayed greater overall object exploration in the novel object recognition test, as well as elevated perseveration during probabilistic reversal learning.In the forced swim and open field tests, SAH mice performed comparably to that of control mice. However, SAH mice exhibited an increased frequency in 'jumping' behavior in the open field test. Histological analyses revealed reduced neuron density in the parietal-entorhinal cortices of SAH mice on the injured side compared to that of control mice. DISCUSSION The findings suggest that parietal-entorhinal damage from SAH increases stereotyped motor behaviors and 'compulsive-like' behaviors without affecting cognition (learning and memory) or mood (anxiety and depression). This model can be used to better understand the neuropathophysiology following SAH that contributes to behavioral impairments in survivors with no gross sensory-motor deficits.
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Affiliation(s)
- Danop Nanegrungsunk
- Department of Anesthesiology, University of Illinois College of Medicine at Chicago , Chicago, IL, USA.,Neuroanesthesia Research Laboratory, University of Illinois College of Medicine , Chicago, IL, USA
| | - Michael E Ragozzino
- Department of Psychologyat the University of Illinois at Chicago , Chicago, IL, USA
| | - Hao-Liang Xu
- Neuroanesthesia Research Laboratory, University of Illinois College of Medicine , Chicago, IL, USA
| | - Kyle J Haselton
- Neuroanesthesia Research Laboratory, University of Illinois College of Medicine , Chicago, IL, USA
| | - Chanannait Paisansathan
- Department of Anesthesiology, University of Illinois College of Medicine at Chicago , Chicago, IL, USA.,Neuroanesthesia Research Laboratory, University of Illinois College of Medicine , Chicago, IL, USA
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16
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Athiraman U, Jayaraman K, Liu M, Giri T, Yuan J, Zipfel GJ. Role of Endothelial Nitric Oxide Synthase in Isoflurane Conditioning-Induced Neurovascular Protection in Subarachnoid Hemorrhage. J Am Heart Assoc 2020; 9:e017477. [PMID: 33030094 PMCID: PMC7763369 DOI: 10.1161/jaha.120.017477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Delayed cerebral ischemia remains a common and profound risk factor for poor outcome after subarachnoid hemorrhage (SAH). The aim of our current study is to define the role of endothelial nitric oxide synthase (eNOS) in isoflurane conditioning‐induced neurovascular protection after SAH. Methods and Results Ten‐ to 14‐week‐old male wild‐type mice (C57BL/6) as controls and eNOS knockout male mice (strain # 002684) were obtained for the study. Animals underwent either sham surgery, SAH surgery, or SAH with isoflurane conditioning. Anesthetic post conditioning was performed with isoflurane 2% for 1 hour, 1 hour after SAH. Normothermia was maintained with the homeothermic blanket. In a separate cohort, nitric oxide synthase was inhibited by a pan nitric oxide synthase inhibitor, L‐nitroarginine methyl ester. Vasospasm measurement was assessed 72 hours after SAH and neurological function was assessed daily. Isoflurane‐induced changes in the eNOS protein expression were measured. eNOS protein expression was significantly increased by isoflurane conditioning in naïve mice as well as mice subjected to SAH. Vasospasm of the middle cerebral artery and neurological deficits were evident following SAH versus sham surgery, both in wild‐type mice and eNOS knockout mice. Isoflurane conditioning attenuated vasospasm and neurological deficits in wild‐type mice. This delayed cerebral ischemia protection was lost in L‐nitroarginine methyl ester ‐administered mice and eNOS knockout mice. Conclusions Our data indicate isoflurane conditioning provides robust protection against SAH‐induced vasospasm and neurological deficits, and that this delayed cerebral ischemia protection is critically mediated via isoflurane‐induced augmentation of eNOS.
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Affiliation(s)
| | - Keshav Jayaraman
- Department of Neurological surgery Washington University St. Louis MO
| | - Meizi Liu
- Department of Anesthesiology Washington University St. Louis MO
| | - Tusar Giri
- Department of Anesthesiology Washington University St. Louis MO
| | - Jane Yuan
- Department of Neurological surgery Washington University St. Louis MO
| | - Gregory J Zipfel
- Department of Neurological surgery Washington University St. Louis MO
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17
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Elarjani T, Almutairi OT, Alhussinan M, Alzhrani G, Alotaibi FE, Bafaquh M, Orz Y, AlYamany M, Alturki AY. Bibliometric Analysis of the Top 100 Most Cited Articles on Cerebral Vasospasm. World Neurosurg 2020; 145:e68-e82. [PMID: 32980568 DOI: 10.1016/j.wneu.2020.09.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Bibliometric analysis reflects the scientific recognition and influential performance of a published article within its field. Our aim is to identify and analyze the top 100 most-cited articles on cerebral vasospasm. METHODS A title-specific search was carried out using the Scopus database. The top 100 cited articles including the keywords "Cerebral Vasospasm" AND "Vasospasm" were retrieved and stratified in a descending order: title, authors, institution, publishing journal, country of origin, year of publication, and topic of each article were studied. RESULTS The top 100 articles have an accumulative citation count of 20,972, with 209 average citations per article. Publication dates ranged from 1968 to 2012, with the most productive years between 1998 and 2005. Clinical studies are the most frequent category, followed by pathophysiology. The list includes 7 clinical trials, which received accumulative citations of 1525. The top cited article had received 2109 citations, with 52.7 citations per year. The top 100 articles were published across 14 countries, with most originating from the United States. The lead research institution was the University of Alberta. The most used journal was Journal of Neurosurgery. CONCLUSIONS Bibliometric analysis has garnered major interest in recent years. It shows the publication trends, knowledge evolution, and evidence-based practice throughout the years. The collection of highly cited articles may assist physicians in gaining a better understanding of the nature of cerebral vasospasm and optimize their clinical practice.
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Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miami, Florida USA
| | - Othman T Almutairi
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Gmaan Alzhrani
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad E Alotaibi
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Orz
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mahmoud AlYamany
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Y Alturki
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Neurocritical Care Divison, Adult Intensive Care Department, Critical Care Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
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18
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Matsumura K, Kumar TP, Guddanti T, Yan Y, Blackburn SL, McBride DW. Neurobehavioral Deficits After Subarachnoid Hemorrhage in Mice: Sensitivity Analysis and Development of a New Composite Score. J Am Heart Assoc 2020; 8:e011699. [PMID: 30971151 PMCID: PMC6507191 DOI: 10.1161/jaha.118.011699] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Because of the failure of numerous clinical trials, various recommendations have been made to improve the usefulness of preclinical studies. Specifically, the STAIR (Stroke Therapy Academic Industry Roundtable) recommendations highlighted functional outcome as a critical measure. Recent reviews of experimental subarachnoid hemorrhage (SAH) studies have brought to light the numerous neurobehavioral scoring systems that are used in preclinical SAH studies. To gain insight into the utility of these scoring systems, as well as to identify a scoring system that best captures the deficits caused by SAH in mice, we designed the current study. Methods and Results Adult male C57BL/6J mice were used. One cohort of mice was randomly allocated to either sham or SAH and had functional testing performed on days 1 to 3 post‐SAH using the modified Bederson Score, Katz Score, Garcia Neuroscore, and Parra Neuroscore, as well as 21 individual subtests. A new composite neuroscore was developed using the 8 most diagnostically accurate subtests. To validate the use of the developed composite neuroscore, another cohort of mice was randomly assigned to either the sham or SAH group and neurobehavior was evaluated on days 1 to 3, 5, and 7 after injury. Receiver operating characteristic curves were used to analyze the diagnostic accuracy of each scoring system, as well as the subtests. Of the 4 published scoring systems, the Parra Neuroscore was diagnostically accurate for SAH injury in mice versus the modified Bederson and Katz Scores, but not the Garcia Neuroscore. However, the newly developed composite neuroscore was found to be statistically more diagnostically accurate than even the Parra Neuroscore. Conclusions The findings of this study promote use of the newly developed composite neuroscore for experimental SAH studies in mice.
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Affiliation(s)
- Kanako Matsumura
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - T Peeyush Kumar
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Tejesh Guddanti
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Yuanqing Yan
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Spiros L Blackburn
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Devin W McBride
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
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19
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Pharmacologic Management of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage. Crit Care Nurs Q 2020; 43:138-156. [DOI: 10.1097/cnq.0000000000000299] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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He J, Zhang L, Yu Y, Luo X, Wei M, Chen G, Shen Y. Effects of clazosentan, cilostazol, and statins on aneurysmal subarachnoid hemorrhage: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19902. [PMID: 32332668 PMCID: PMC7440251 DOI: 10.1097/md.0000000000019902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a disease caused by the infiltration of blood into the subarachnoid space due to the rupture of an intracranial aneurysm. It is a serious cerebrovascular disease, with a mortality rate of about 40% worldwide, which seriously threatens human life and health. Many drugs are used to treat aSAH and its complications, and some have been tested in systematic reviews and have shown good effects. But which drug has the best effect remains unclear. This network meta-analysis (NMA) aims to assess the effectiveness and feasibility of clazosentan, cilostazol, and statins in patients with aSAH. METHODS We will search for EMBASE.com, PubMed, the Cochrane Library, and Web of Science from inception to December 2019. Randomized controlled trials (RCTs) reporting efficacy and safety of clazosentan, cilostazol, and statins compared with the control, or compared with each other for the treatment of aSAH will be included. Two independent reviewers will assess the risk of bias of the included RCTs with the Cochrane "Risk of bias" tool. The pairwise meta-analysis will be performed with the random-effects model. The NMA will be performed in a Bayesian hierarchical framework using Markov Chain Monte Carlo method in WinBUGS 1.4.3. Egger test and funnel plot will be used to assess the publication bias. We will evaluate the quality of evidence for each outcome according to the GRADE approach. RESULTS The results of this NMA will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will summarize up-to-date evidence to compare the efficacy and safety of clazosentan, cilostazol, and statins on aSAH.PROSPERO registration number: CRD42019147523.
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Affiliation(s)
- Junfang He
- Department of Neurological Rehabilitation, Rehabilitation Center Hospital of Gansu Province
| | - Li Zhang
- The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine
| | - Yao Yu
- Pathogens Biology Institute, School of Basic Medical Sciences of Lanzhou University
| | - Xinyue Luo
- The Second Clinical Medical College of Lanzhou University
| | - Min Wei
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou
| | - Gen Chen
- Pathogens Biology Institute, School of Basic Medical Sciences of Lanzhou University
- Basic Medical School, Guilin Medical University, Guilin
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21
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Okada T, Suzuki H. Mechanisms of neuroinflammation and inflammatory mediators involved in brain injury following subarachnoid hemorrhage. Histol Histopathol 2020; 35:623-636. [PMID: 32026458 DOI: 10.14670/hh-18-208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular disorder. Neuroinflammation is a critical cause of brain injury following SAH in both acute and chronic phases. While accumulating evidence has shown that therapies targeting neuroinflammation exerted beneficial effects in experimental SAH, there is little clinical evidence. One of the factors making neuroinflammation complicated is that inflammatory signaling pathways and mediators act as protective or detrimental responses at different phases. In addition, biomarkers to detect neuroinflammation are little known in clinical settings. In this review, first, we discuss how the inflammatory signaling pathways contribute to brain injury and other secondary pathophysiological changes in SAH. Damage-associated molecular patterns arising from mechanical stress, transient global cerebral ischemia, red blood cell breakdown and delayed cerebral ischemia following SAH trigger to activate pattern recognition receptors (PRRs) such as Toll-like receptors, nucleotide-binding oligomerization domain-like receptors, and receptors for advanced glycation end products. Most of PRRs activate common downstream signaling transcriptional factor nuclear factor-κΒ and mitogen-activated protein kinases, releasing pro-inflammatory mediators and cytokines. Next, we focus on how pro-inflammatory substances play a role during the course of SAH. Finally, we highlight an important inducer of neuroinflammation, matricellular protein (MCP). MCPs are a component of extracellular matrix and exert beneficial and harmful effects through binding to receptors, other matrix proteins, growth factors, and cytokines. Treatment targeting MCPs is being proved efficacious in pre-clinical models for preventing brain injury including neuroinflammation in SAH. In addition, MCPs may be a candidate of biomarkers predicting brain injury following SAH in clinical settings.
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Affiliation(s)
- Takeshi Okada
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.,Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
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22
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Kimer N, Grønbæk H, Fred RG, Hansen T, Deshmukh AS, Mann M, Bendtsen F. Atorvastatin for prevention of disease progression and hospitalisation in liver cirrhosis: protocol for a randomised, double-blind, placebo-controlled trial. BMJ Open 2020; 10:e035284. [PMID: 31980514 PMCID: PMC7045122 DOI: 10.1136/bmjopen-2019-035284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Patients with liver cirrhosis are often diagnosed late and once complications are present, the 2-year survival is 50%. Increasing evidence supports systemic inflammation and metabolic dysfunction in the hepatic stellate cell as key drivers of progression of cirrhosis. However, there is no registered medication, that targets inflammation and cellular dysfunction in the liver. METHODS AND ANALYSIS In a randomised double-blind and placebo-controlled trial with atorvastatin for liver cirrhosis, we aim to investigate clinical endpoints of survival, hospitalisations and safety, but also exploratory endpoints of genomics and protein functions in the liver. ETHICS AND DISSEMINATION There is no registered medication that actively prevents development of complications or systemic inflammation in liver cirrhosis. All patients continue regular clinical management during the trial period. Atorvastatin has been on the market for several years with a safety profile that is acceptable even in patients with liver disease. A beneficial effect of atorvastatin on clinical outcomes in cirrhosis will provide cheap and effective causal treatment for chronic liver disease. The trial is registered by the Danish Data Protection Agency (P-2019-635) and approved by the Danish Medicines Agency (EudraCT 2019-001806-40) and the Scientific Ethics Committee of the Capital Region of Denmark (H-19030643) before initiation. Reporting of the trial will follow the Consolidated Standards of Reporting Trials guidelines for reporting of randomised clinical trials. TRIAL REGISTRATION NUMBER The trial is registered in clinicaltrials.gov (NCT04072601) and in clinicaltrialsregister.eu (EudraCT 2019-001806-40) (Pre-results).
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Affiliation(s)
- Nina Kimer
- Gastro Unit, Medical Division, Hvidovre Hospital, Hvidovre, Denmark
- Novo Nordisk Foundation Centre for Basic Metabolic Research, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikard Gøran Fred
- Novo Nordisk Foundation Centre for Basic Metabolic Research, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Centre for Basic Metabolic Research, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Atul Shahaji Deshmukh
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mathias Mann
- Clinical Proteomics Group, Proteomics Program, Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, 2200 Copenhagen, Denmark
- Max-Planck-Institute of Biochemistry, Martinsried, Munich, Bayern, Germany
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23
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Hou G, Chen H, Yin Y, Pan Y, Zhang X, Jia F. MEL Ameliorates Post-SAH Cerebral Vasospasm by Affecting the Expression of eNOS and HIF1α via H19/miR-138/eNOS/NO and H19/miR-675/HIF1α. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 19:523-532. [PMID: 31927306 PMCID: PMC6953775 DOI: 10.1016/j.omtn.2019.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/29/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
Melatonin (MEL) has been demonstrated to exert a protective effect against subarachnoid hemorrhage (SAH), and nitric oxide (NO) has been shown to play an important role in the pathogenesis of vasospasm. This study aims to explore the underlying molecular mechanisms of MEL in the control of vasospasm following SAH. MEL administration attenuates SAH-induced vasospasm and neurobehavioral deficits. Expressions of H19, eNOS, and miR-675 are low in the SAH group, while expressions of miR-138 and HIF1α are high in the SAH group. Also, MEL treatment upon SAH rats completely restores the dysregulation of H19, eNOS, miR-675, miR-138, and HIF1α to their normal levels. Moreover, MEL dose dependently increases the luciferase activity of H19 promoter and hence the expression of H19. Additionally, H19 directly targets miR-675 and miR-138 to increase miR-675 expression and inhibit miR-138 expression. As virtual target genes of miR-675 and miR-138, respectively, HIF1α and eNOS are also regulated by the treatment with MEL. In particular, MEL treatment increases the expression of miR-675 and eNOS level while decreasing the expression of miR-138 and HIF1α in a dose dependent manner. Our study found that MEL ameliorates post-SAH vasospasm by regulating the expression of eNOS and HIF1α via the H19/miR-138/eNOS/NO and H19/miR-675/HIF1α signaling pathways.
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Affiliation(s)
- Guoqiang Hou
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China
| | - Hongjin Chen
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China
| | - Yuhua Yin
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China
| | - Yaohua Pan
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China.
| | - Xiaohua Zhang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China.
| | - Feng Jia
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China.
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24
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Daou BJ, Koduri S, Thompson BG, Chaudhary N, Pandey AS. Clinical and experimental aspects of aneurysmal subarachnoid hemorrhage. CNS Neurosci Ther 2019; 25:1096-1112. [PMID: 31583833 PMCID: PMC6776745 DOI: 10.1111/cns.13222] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/30/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) continues to be associated with significant morbidity and mortality despite advances in care and aneurysm treatment strategies. Cerebral vasospasm continues to be a major source of clinical worsening in patients. We intended to review the clinical and experimental aspects of aSAH and identify strategies that are being evaluated for the treatment of vasospasm. A literature review on aSAH and cerebral vasospasm was performed. Available treatments for aSAH continue to expand as research continues to identify new therapeutic targets. Oral nimodipine is the primary medication used in practice given its neuroprotective properties. Transluminal balloon angioplasty is widely utilized in patients with symptomatic vasospasm and ischemia. Prophylactic "triple-H" therapy, clazosentan, and intraarterial papaverine have fallen out of practice. Trials have not shown strong evidence supporting magnesium or statins. Other calcium channel blockers, milrinone, tirilazad, fasudil, cilostazol, albumin, eicosapentaenoic acid, erythropoietin, corticosteroids, minocycline, deferoxamine, intrathecal thrombolytics, need to be further investigated. Many of the current experimental drugs may have significant roles in the treatment algorithm, and further clinical trials are needed. There is growing evidence supporting that early brain injury in aSAH may lead to significant morbidity and mortality, and this needs to be explored further.
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Affiliation(s)
- Badih J. Daou
- Department of Neurological SurgeryUniversity of MichiganAnn ArborMichigan
| | - Sravanthi Koduri
- Department of Neurological SurgeryUniversity of MichiganAnn ArborMichigan
| | | | - Neeraj Chaudhary
- Department of Neurological SurgeryUniversity of MichiganAnn ArborMichigan
| | - Aditya S. Pandey
- Department of Neurological SurgeryUniversity of MichiganAnn ArborMichigan
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25
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Zhang HS, Hong H, Zeng DY, Xie LN, Cheng Q, Pang XF, Guan QG. Atorvastatin suppresses vascular hypersensitivity and remodeling induced by transient adventitial administration of lipopolysaccharide in rats. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:386. [PMID: 31555700 DOI: 10.21037/atm.2019.07.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The phenotypic transition of vascular smooth muscle cells (VSMCs) from a contractile to a proliferative state markedly affects the pathophysiology of cardiovascular diseases. The adventitial inflammation can promote neointimal formation and vascular remodeling. We used direct administration of lipopolysaccharide (LPS) into the periphery of the carotid artery to investigate the influence of transient adventitial inflammation on vascular remodeling and its potential mechanism. Methods Male 15-week-old Wistar rats were randomly assigned to four groups with six rats in each group. The rats of groups I and II were administered distilled water, and group III and IV were treated with fasudil and atorvastatin respectively. All treatments were given daily for 11 days. On day 8, the adventitia in group I was injected with 5 µL sterile saline, and the group II-IV were injected with 5 µL sterilized LPS. The carotid blood flow and femoral blood pressure were measured in vivo, and the thickness of vascular intima and middle layer was measured in vitro. Serum interleukin-6 (IL-6) and tumor necrosis factor α (TNFα) were determined using enzyme-linked immunosorbent assay (ELISA) assay. And the Rho-associated coiled-coil-containing protein kinase 2 (ROCK2), myosin phosphatase target subunit 1 (MYPT1), myosin light chain (MLC), myocardin, SM-α actin or glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were detected by western blot. The comparisons were made by one-way analysis of variance with Bonferroni's post hoc test. A value of P<0.05 was considered to represent a statistically significant difference. Results Transient adventitial inflammation induced by LPS caused no obvious change in basal blood flow, but did lead to vascular hypersensitivity to serotonin. Morphological examinations revealed that the medial layer was the only domain affected, and showed VSMC proliferation and rearrangement. LPS increased serum IL-6 and TNFα contents, ROCK2 expression and activity, and caused changes in the expression levels of some stereotypical VSMC genes. Similar to the Rho-kinase inhibitor fasudil, atorvastatin completely restored the morphological alterations, even increased blood flow. Conclusions Our study confirms the beneficial effect of atorvastatin on the vascular system in terms of morphology and function.
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Affiliation(s)
- Hai-Shan Zhang
- Department of Cardiology, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
| | - Hong Hong
- Department of Geriatrics, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
| | - Ding-Yin Zeng
- Department of Cardiology, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
| | - Lian-Na Xie
- Department of Cardiology, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
| | - Qiu Cheng
- Department of Cardiology, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
| | - Xue-Feng Pang
- Department of Cardiology, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
| | - Qi-Gang Guan
- Department of Cardiology, The First Affiliated Hospital, China Medial University, Shenyang 110001, China
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26
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Nykänen AI, Holmström EJ, Tuuminen R, Krebs R, Dhaygude K, Kankainen M, Jokinen JJ, Lommi J, Helanterä I, Räisänen-Sokolowski A, Syrjälä SO, Lemström KB. Donor Simvastatin Treatment in Heart Transplantation. Circulation 2019; 140:627-640. [PMID: 31352795 DOI: 10.1161/circulationaha.119.039932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury may compromise the short-term and long-term prognosis after heart transplantation. Experimental studies show that simvastatin administered to the organ donor is vasculoprotective and inhibits cardiac allograft ischemia-reperfusion injury. METHODS Eighty-four multiorgan donors were randomly assigned to receive 80 mg of simvastatin (42 donors) via nasogastric tube after declaration of brain death and upon acceptance as a cardiac donor, or to receive no simvastatin (42 donors). The primary efficacy end point was postoperative plasma troponin T and I levels during the first 24 hours after heart transplantation. Secondary end points included postoperative hemodynamics, inflammation, allograft function, rejections and rejection treatments, and mortality. Results: Organ donor simvastatin treatment significantly reduced the heart recipient plasma levels of troponin T by 34% (14 900 ± 12 100 ng/L to 9800 ± 7900 ng/L, P=0.047), and troponin I by 40% (171 000 ± 151 000 ng/L to 103 000 ± 109 000 ng/L, P=0.023) at 6 hours after reperfusion, the levels of NT-proBNP (N-terminal pro-B-type natriuretic peptide) by 36% (32 800 ± 24 300 ng/L to 20 900 ± 15 900 ng/L; P=0.011) at 1 week, and the number of rejection treatments with hemodynamic compromise by 53% within the first 30 days (P=0.046). Donor simvastatin treatment did not affect donor lipid levels but was associated with a specific transplant myocardial biopsy gene expression profile, and a decrease in recipient postoperative plasma levels of CXCL10 (C-X-C motif chemokine 10), interleukin-1α, placental growth factor, and platelet-derived growth factor-BB. Postoperative hemodynamics, biopsy-proven acute rejections, and mortality were similar. No adverse effects were seen in recipients receiving noncardiac solid organ transplants from simvastatin-treated donors. CONCLUSIONS Donor simvastatin treatment reduces biomarkers of myocardial injury after heart transplantation, and-also considering its documented general safety profile-may be used as a novel, safe, and inexpensive adjunct therapy in multiorgan donation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01160978.
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Affiliation(s)
- Antti I Nykänen
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Department of Cardiothoracic Surgery (A.I.N., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Emil J Holmström
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Raimo Tuuminen
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Rainer Krebs
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Kishor Dhaygude
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Matti Kankainen
- Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Medical and Clinical Genetics (M.K.), University of Helsinki and Helsinki University Hospital, Finland.,Institute for Molecular Medicine Finland, University of Helsinki (M.K.)
| | - Janne J Jokinen
- Department of Cardiology (J.L.), University of Helsinki and Helsinki University Hospital, Finland.,Päijät-Häme Central Hospital, Department of Surgery, Lahti, Finland (J.J.J.)
| | | | - Ilkka Helanterä
- Transplantation and Liver Surgery (I.H.), University of Helsinki and Helsinki University Hospital, Finland
| | | | - Simo O Syrjälä
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Department of Cardiothoracic Surgery (A.I.N., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Karl B Lemström
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Department of Cardiothoracic Surgery (A.I.N., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
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27
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Saand AR, Yu F, Chen J, Chou SHY. Systemic inflammation in hemorrhagic strokes - A novel neurological sign and therapeutic target? J Cereb Blood Flow Metab 2019; 39:959-988. [PMID: 30961425 PMCID: PMC6547186 DOI: 10.1177/0271678x19841443] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Growing evidences suggest that stroke is a systemic disease affecting many organ systems beyond the brain. Stroke-related systemic inflammatory response and immune dysregulations may play an important role in brain injury, recovery, and stroke outcome. The two main phenomena in stroke-related peripheral immune dysregulations are systemic inflammation and post-stroke immunosuppression. There is emerging evidence suggesting that the spleen contracts following ischemic stroke, activates peripheral immune response and this may further potentiate brain injury. Whether similar brain-immune crosstalk occurs in hemorrhagic strokes such as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) is not established. In this review, we systematically examined animal and human evidence to date on peripheral immune responses associated with hemorrhagic strokes. Specifically, we reviewed the impact of clinical systemic inflammatory response syndrome (SIRS), inflammation- and immune-associated biomarkers, the brain-spleen interaction, and cellular mediators of peripheral immune responses to ICH and SAH including regulatory T cells (Tregs). While there is growing data suggesting that peripheral immune dysregulation following hemorrhagic strokes may be important in brain injury pathogenesis and outcome, details of this brain-immune system cross-talk remain insufficiently understood. This is an important unmet scientific need that may lead to novel therapeutic strategies in this highly morbid condition.
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Affiliation(s)
- Aisha R Saand
- 1 Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fang Yu
- 2 Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jun Chen
- 2 Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sherry H-Y Chou
- 1 Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,3 Department of Neurosurgery, School of Medicine, University of Pittsburgh, PA, USA
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28
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Neulen A, Meyer S, Kramer A, Pantel T, Kosterhon M, Kunzelmann S, Goetz H, Thal SC. Large Vessel Vasospasm Is Not Associated with Cerebral Cortical Hypoperfusion in a Murine Model of Subarachnoid Hemorrhage. Transl Stroke Res 2018; 10:10.1007/s12975-018-0647-6. [PMID: 30003500 PMCID: PMC6526146 DOI: 10.1007/s12975-018-0647-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 01/01/2023]
Abstract
Clinical studies on subarachnoid hemorrhage (SAH) have shown discrepancies between large vessel vasospasm, cerebral perfusion, and clinical outcome. We set out to analyze the contribution of large vessel vasospasm to impaired cerebral perfusion and neurological impairment in a murine model of SAH. SAH was induced in C57BL/6 mice by endovascular filament perforation. Vasospasm was analyzed with microcomputed tomography, cortical perfusion by laser SPECKLE contrast imaging, and functional impairment with a quantitative neuroscore. SAH animals developed large vessel vasospasm, as shown by significantly lower vessel volumes of a 2.5-mm segment of the left middle cerebral artery (MCA) (SAH 5.6 ± 0.6 nL, sham 8.3 ± 0.5 nL, p < 0.01). Induction of SAH significantly reduced cerebral perfusion of the corresponding left MCA territory compared to values before SAH, which only recovered partly (SAH vs. sham, 15 min 35.7 ± 3.1 vs. 101.4 ± 10.2%, p < 0.01; 3 h, 85.0 ± 8.6 vs. 121.9 ± 13.4, p < 0.05; 24 h, 75.3 ± 4.6 vs. 110.6 ± 11.4%, p < 0.01; 72 h, 81.8 ± 4.8 vs. 108.5 ± 14.5%, n.s.). MCA vessel volume did not correlate significantly with MCA perfusion after 72 h (r = 0.34, p = 0.25). Perfusion correlated moderately with neuroscore (24 h: r = - 0.58, p < 0.05; 72 h: r = - 0.44, p = 0.14). There was no significant correlation between vessel volume and neuroscore after 72 h (r = - 0.21, p = 0.50). In the murine SAH model, cerebral hypoperfusion occurs independently of large vessel vasospasm. Neurological outcome is associated with cortical hypoperfusion rather than large vessel vasospasm.
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Affiliation(s)
- Axel Neulen
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Simon Meyer
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Andreas Kramer
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Tobias Pantel
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Michael Kosterhon
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Svenja Kunzelmann
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Hermann Goetz
- Platform for Biomaterial Research, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Serge C Thal
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany.
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29
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Abstract
Many strains of mice are utilized in mouse models of cerebrovascular diseases. Variations in vascular anatomy between these strains has been documented and may influence the phenotype in stroke models. To address inter-strain variations in the circle of Willis anatomy, the diameters of internal carotid, posterior communicating, anterior cerebral, and middle cerebral arteries in 144 mice from 32 inbred strains were measured. Arterial diameters were analyzed as a function of animal weight, age, and strain. Variations in the structure of the circle of Willis across strains were observed and noted. While right-sided anterior cerebral arteries were significantly greater in diameter than their left-sided counterparts across most strains, variations in arterial diameter are strain specific. Adult mouse weight was not found to be associated with arterial diameter across strains, suggesting that cerebral artery size is associated with strain independently of weight. This study demonstrates strain dependent variations in the murine circle of Willis, which should be taken into consideration when studying mouse models of cerebrovascular diseases.
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Affiliation(s)
- Baogang Qian
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Robert F Rudy
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Tianxi Cai
- Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
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30
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Turan N, Miller BA, Heider RA, Nadeem M, Sayeed I, Stein DG, Pradilla G. Neurobehavioral testing in subarachnoid hemorrhage: A review of methods and current findings in rodents. J Cereb Blood Flow Metab 2017; 37:3461-3474. [PMID: 27677672 PMCID: PMC5669338 DOI: 10.1177/0271678x16665623] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The most important aspect of a preclinical study seeking to develop a novel therapy for neurological diseases is whether the therapy produces any clinically relevant functional recovery. For this purpose, neurobehavioral tests are commonly used to evaluate the neuroprotective efficacy of treatments in a wide array of cerebrovascular diseases and neurotrauma. Their use, however, has been limited in experimental subarachnoid hemorrhage studies. After several randomized, double-blinded, controlled clinical trials repeatedly failed to produce a benefit in functional outcome despite some improvement in angiographic vasospasm, more rigorous methods of neurobehavioral testing became critical to provide a more comprehensive evaluation of the functional efficacy of proposed treatments. While several subarachnoid hemorrhage studies have incorporated an array of neurobehavioral assays, a standardized methodology has not been agreed upon. Here, we review neurobehavioral tests for rodents and their potential application to subarachnoid hemorrhage studies. Developing a standardized neurobehavioral testing regimen in rodent studies of subarachnoid hemorrhage would allow for better comparison of results between laboratories and a better prediction of what interventions would produce functional benefits in humans.
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Affiliation(s)
- Nefize Turan
- 1 Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Brandon A Miller
- 1 Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert A Heider
- 1 Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Maheen Nadeem
- 1 Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Iqbal Sayeed
- 2 Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald G Stein
- 2 Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gustavo Pradilla
- 1 Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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Effect of High-Dose Simvastatin on Cerebral Blood Flow and Static Autoregulation in Subarachnoid Hemorrhage. Neurocrit Care 2017; 25:56-63. [PMID: 26721259 DOI: 10.1007/s12028-015-0233-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Statins may promote vasodilation following subarachnoid hemorrhage (SAH) and improve the response to blood pressure elevation. We sought to determine whether simvastatin increases cerebral blood flow (CBF) and alters the response to induced hypertension after SAH. METHODS Statin-naïve patients admitted <72 h after WFNS ≥2 aneurysmal SAH were randomly assigned to 80 mg simvastatin/day or placebo for 21 days. Regional CBF was measured with quantitative (15)O PET on SAH day 7-10 before and after raising mean arterial pressure (MAP) 20-25 %. Autoregulatory index (AI) was calculated as the ratio of % change in resistance (MAP/CBF) to % change in MAP. Angiography was performed within 24 h of PET. Results are presented as simvastatin vs. placebo. RESULTS Thirteen patients received simvastatin and 12 placebo. Clinical characteristics were similar. Moderate or severe angiographic vasospasm occurred in 42 vs. 45 % and delayed cerebral ischemia in 14 vs. 55 % (p = 0.074). During PET studies, MAP (110 ± 10 vs. 111 ± 12), global CBF (41 ± 12 vs. 43 ± 13), and CVR (2.95 ± 1.0 vs. 2.81 ± 1.0) did not differ at baseline. When MAP was raised to 135 ± 7 mm Hg vs. 137 ± 15, global CBF did not change. Global AI did not differ (107 ± 59 vs. 0. 89 ± 52 %, p = 0.68). CBF did not change in regions with low baseline flow or in regions supplied by vessels with angiographic vasospasm in either group. Six-month modified Rankin Scale scores did not differ. CONCLUSIONS Our data indicate that initiation of therapy with high-dose simvastatin does not alter baseline CBF or response to induced hypertension.
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Zhou X, Chen J, Wang C, Wu L. Anti-inflammatory effects of Simvastatin in patients with acute intracerebral hemorrhage in an intensive care unit. Exp Ther Med 2017; 14:6193-6200. [PMID: 29285177 PMCID: PMC5740808 DOI: 10.3892/etm.2017.5309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 04/28/2017] [Indexed: 01/01/2023] Open
Abstract
Intracerebral hemorrhage is one of the most common types of cerebrovascular disease in humans and often causes paralysis, a vegetative state and even death. Patients with acute intracerebral hemorrhage are frequently monitored in intensive care units (ICUs). Spontaneous intracerebral hemorrhage is associated with a higher rate of mortality and morbidity than other intracephalic diseases. The expression levels of inflammatory factors have important roles in inflammatory responses indicative of changes in a patient's condition and are therefore important in the monitoring and treatment of affected patients at the ICU as well as the development of therapeutic strategies for acute cerebral hemorrhage. The present study investigated the anti-inflammatory effects of Simvastatin in patients with acute intracerebral hemorrhage at an ICU, and inflammatory factors and cellular changes were systematically analyzed. The plasma concentrations of inflammatory factors, including interleukin (IL)-4, IL-6, IL-8 and IL-10, were evaluated by ELISAs. The plasma concentrations of inflammatory cellular changes were detected by using flow cytometry. The results demonstrated that after Simvastatin treatment of patients with acute cerebral hemorrhage at the ICU, the plasma concentrations of IL-4, IL-6, IL-8 and IL-10 were downregulated compared with those in placebo-treated controls. In addition, Simvastatin treatment at the ICU decreased lymphocytes, granulocytes and mononuclear cells in patients with acute cerebral hemorrhage. The levels of inflammatory factors were associated with brain edema in patients with acute cerebral hemorrhage treated at the ICU. In addition, the amount of bleeding was reduced in parallel with the inflammatory cell plasma concentration of lymphocytes, granulocytes and mononuclear cells. Importantly, Simvastatin treatment produced beneficial outcomes by improving brain edema and reducing the amount of bleeding. In conclusion, the present study demonstrated the efficacy of Simvastatin in treating acute intracerebral hemorrhage and evidenced the association between inflammatory responses and the progress of affected patients at the ICU, thereby providing insight for applying effective therapies for patients with acute intracerebral hemorrhage.
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Affiliation(s)
- Xiurong Zhou
- Department of Neurosurgery, People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Jiafeng Chen
- Department of Neurology, People's Hospital, Weifang, Shandong 261041, P.R. China.,Intensive Care Unit, People's Hospital of Changle County, Weifang, Shandong 262400, P.R. China
| | - Chengdong Wang
- Central Laboratory, People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Lili Wu
- Department of Neurology, People's Hospital, Weifang, Shandong 261041, P.R. China
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33
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Kim RG, Loomba R, Prokop LJ, Singh S. Statin Use and Risk of Cirrhosis and Related Complications in Patients With Chronic Liver Diseases: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2017; 15:1521-1530.e8. [PMID: 28479502 PMCID: PMC5605397 DOI: 10.1016/j.cgh.2017.04.039] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Statins have been variably shown to decrease risk and complications of chronic liver diseases (CLDs). We performed a systematic review and meta-analysis to evaluate the association between statins and risk of cirrhosis and related complications in patients with CLDs. METHODS Through a systematic literature search up to March 2017, we identified 13 studies (3 randomized trials, 10 cohort studies) in adults with CLDs, reporting the association between statin use and risk of development of cirrhosis, decompensated cirrhosis, improvements in portal hypertension, or mortality. Pooled relative risk (RR) estimates with 95% confidence interval (CIs) were calculated using random effects model. Grading of Recommendations Assessment, Development and Evaluation criteria were used to assess quality of evidence. RESULTS Among 121,058 patients with CLDs (84.5% with hepatitis C), 46% were exposed to statins. In patients with cirrhosis, statin use was associated with 46% lower risk of hepatic decompensation (4 studies; RR, 0.54; 95% CI, 0.46-0.62; I2 = 0%; moderate-quality evidence), and 46% lower mortality (5 studies; RR, 0.54; 95% CI, 0.47-0.61; I2 = 10%; moderate-quality evidence). In patients with CLD without cirrhosis, statin use was associated with a nonsignificant (58% lower) risk of development of cirrhosis or fibrosis progression (5 studies; RR, 0.42; 95% CI, 0.16-1.11; I2 = 99%; very-low-quality evidence). In 3 randomized controlled trials, statin use was associated with 27% lower risk of variceal bleeding or progression of portal hypertension (hazard ratio, 0.73; 95% CI, 0.59-0.91; I2 = 0%; moderate-quality evidence). CONCLUSIONS Based on a systematic review and meta-analysis, statin use is probably associated with lower risk of hepatic decompensation and mortality, and might reduce portal hypertension, in patients with CLDs. Prospective observational studies and randomized controlled trials are needed to confirm this observation.
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Affiliation(s)
- Rebecca G Kim
- Division of Internal Medicine, Department of Medicine, University of California at San Diego, La Jolla, California
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California; Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, La Jolla, California
| | - Larry J Prokop
- Department of Library Services, Mayo Clinic, Rochester, Minnesota
| | - Siddharth Singh
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California at San Diego, La Jolla, California.
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Aum DJ, Vellimana AK, Singh I, Milner E, Nelson JW, Han BH, Zipfel GJ. A novel fluorescent imaging technique for assessment of cerebral vasospasm after experimental subarachnoid hemorrhage. Sci Rep 2017; 7:9126. [PMID: 28831103 PMCID: PMC5567362 DOI: 10.1038/s41598-017-09070-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/21/2017] [Indexed: 12/22/2022] Open
Abstract
Various techniques have been developed to study changes in the cerebral vasculature in numerous neuropathological processes including subarachnoid hemorrhage (SAH). One of the most widely employed techniques uses India ink-gelatin casting, which presents numerous challenges due to its high viscosity, rapid solidification, and its impact on immunohistochemical analysis. To overcome these limitations, we developed a novel technique for assessing cerebral vasospasm using cerebrovascular perfusion with ROX, SE (5-Carboxy-X-Rhodamine, Succinimidyl Ester), a fluorescent labeling dye. We found that ROX SE perfusion achieves excellent delineation of the cerebral vasculature, was qualitatively and quantitatively superior to India ink-gelatin casting for the assessment of cerebral vasospasm, permits outstanding immunohistochemical examination of non-vasospasm components of secondary brain injury, and is a more efficient and cost-effective experimental technique. ROX SE perfusion is therefore a novel and highly useful technique for studying cerebrovascular pathology following experimental SAH.
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Affiliation(s)
- Diane J Aum
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Ananth K Vellimana
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Itender Singh
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Eric Milner
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - James W Nelson
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Byung Hee Han
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA.,Department of Pharmacology, A.T. Still University of Health Sciences, Kirksville, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO, USA. .,Department of Neurology, Washington University School of Medicine, St Louis, MO, USA.
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Cholesterol-Reducing Agents for Treatment of Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2017; 101:476-485. [DOI: 10.1016/j.wneu.2017.01.125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 11/20/2022]
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Dose-related effect of statins in patients with endovascular coiling or microsurgical clipping for aneurysmal subarachnoid hemorrhage: updated study-level meta-analysis. Eur J Clin Pharmacol 2017; 73:1071-1081. [PMID: 28293714 DOI: 10.1007/s00228-017-2221-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to quantitatively assess the effects of short-term statin use on delayed ischemic neurologic deficits (DINDs) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH) through a meta-analysis of the available evidence. METHODS We searched the electronic databases up to April 8, 2016 to retrieve relevant studies comparing the outcomes between immediate statin-treated in statin-naïve patients and untreated patients following aneurysmal SAH. Meta-analysis was performed using Review Manager 5.3. RESULTS Eight randomized controlled clinical trials (RCTs) and 5 observational studies involving 2148 patients met the eligibility criteria. In the RCTs, statins were found to significantly reduce the occurrence of DINDs (relative risk (RR), 0.76; 95% confidence interval (CI), 0.61-0.94; P = 0.01), but did not significantly reduce poor functional outcomes (RR, 1.01; 95% CI, 0.87-1.16; P = 0.93) or mortality (RR, 0.80; 95% CI, 0.58-1.11; P = 0.18). In observational studies, statin use was not associated with any reduction in DINDs, poor outcome, or mortality. Meta-analysis of RCTs indicated a significant reduction in DINDs and mortality in patients with high-dose statin use (RR, 0.63; 95% CI, 0.42-0.95; P = 0.03; I 2 = 0%; and RR, 0.36; 95% CI, 0.15-0.86; P = 0.02; I 2 = 0%, respectively). CONCLUSION The present meta-analysis suggests that statin use may prevent DINDs in patients with aneurysmal SAH. Based on our findings, the role of statins in improving neurological outcome was limited. However, the risk of DINDs and mortality decreased with higher statin doses in a dose-dependent manner. Hence, further well-designed RCTs with modified protocols in specific patients are required.
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37
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Kamp MA, Lieshout JHV, Dibué-Adjei M, Weber JK, Schneider T, Restin T, Fischer I, Steiger HJ. A Systematic and Meta-Analysis of Mortality in Experimental Mouse Models Analyzing Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Transl Stroke Res 2017; 8:206-219. [DOI: 10.1007/s12975-016-0513-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/23/2016] [Accepted: 11/27/2016] [Indexed: 01/18/2023]
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38
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Li Q, Chen Y, Zhang X, Zuo S, Ge H, Chen Y, Liu X, Zhang JH, Ruan H, Feng H. Scutellarin attenuates vasospasm through the Erk5-KLF2-eNOS pathway after subarachnoid hemorrhage in rats. J Clin Neurosci 2016; 34:264-270. [PMID: 27742373 DOI: 10.1016/j.jocn.2016.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/19/2016] [Accepted: 09/06/2016] [Indexed: 12/29/2022]
Abstract
Angiographic vasospasm, especially in the early phases (<72h) of subarachnoid hemorrhage (SAH), is one of the major complications after an aneurysm rupture and is often the cause of delayed neurological deterioration. Scutellarin (SCU), a flavonoid extracted from the traditional Chinese herb Erigeron breviscapus, has been widely accepted as an antioxidant, but the effect of SCU on vasospasm after SAH remains elusive. Endovascular perforation was conducted to induce SAH in Sprague-Dawley rats. Then, the underlying mechanism of the anti-vasospasm effect of SCU was investigated using a modified Garcia scale, India ink angiography, cross-sectional area analysis, immunohistochemistry staining and western blot. SCU (50μM, 100mg/kg) alleviated angiographic vasospasm and improved neurological function 48h after SAH and enhanced the expression of endothelial nitric oxide synthase (eNOS) at the intima of cerebral arteries. In addition, SCU upregulated the expression of phosphorylated extracellular-regulated kinase 5 (p-Erk5) and Kruppel-like factor 2 (KLF2) at 48h after SAH. However, the effects of SCU were reversed by the Erk5 inhibitor XMD8-92. Our results indicate that SCU could attenuate vasospasm and neurological deficits via modulating the Erk5-KLF2-eNOS pathway after SAH, which may provide an experimental basis for the clinical use of SCU treatment in SAH patients.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China; Department of Neurobiology, College of Basic Medical Sciences, Third Military Medical University, Chongqing, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China
| | - Xuan Zhang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China
| | - Shilun Zuo
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China
| | - Hongfei Ge
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China
| | - Yanyan Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China
| | - Xin Liu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China
| | - John H Zhang
- Department of Anesthesiology, Neurosurgery and Physiology, Loma Linda University, Loma Linda, CA, USA
| | - Huaizhen Ruan
- Department of Neurobiology, College of Basic Medical Sciences, Third Military Medical University, Chongqing, China.
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China.
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Shen J, Huang KY, Zhu Y, Pan JW, Jiang H, Weng YX, Zhan RY. Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg 2016; 127:291-301. [PMID: 27715439 DOI: 10.3171/2016.5.jns152900] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The efficacy of statin therapy in treating aneurysmal subarachnoid hemorrhage (SAH) remains controversial. In this meta-analysis, the authors investigated whether statin treatment significantly reduced the incidence of cerebral vasospasm and delayed neurological deficits, promoting a better outcome after aneurysmal SAH. METHODS A literature search of the PubMed, Ovid, and Cochrane Library databases was performed for randomized controlled trials (RCTs) and prospective cohort studies investigating the effect of statin treatment. The end points of cerebral vasospasm, delayed ischemic neurological deficit (DIND), delayed cerebral infarction, mortality, and favorable outcome were statistically analyzed. RESULTS Six RCTs and 2 prospective cohort studies met the eligibility criteria, and a total of 1461 patients were included. The meta-analysis demonstrated a significant decrease in the incidence of cerebral vasospasm (relative risk [RR] 0.76, 95% confidence interval [CI] 0.61-0.96) in patients treated with statins after aneurysmal SAH. However, no significant benefit was observed for DIND (RR 0.88, 95% CI 0.70-1.12), delayed cerebral infarction (RR 0.66, 95% CI 0.33-1.31), mortality (RR 0.69, 95% CI 0.39-1.24) or favorable outcome, according to assessment by the modified Rankin Scale or Glasgow Outcome Scale (RR 0.99, 95% CI 0.92-1.17). CONCLUSIONS Treatment with statins significantly decreased the occurrence of vasospasm after aneurysmal SAH. The incidence of DIND, delayed cerebral infarction, and mortality were not affected by statin treatment. Future research should focus on DIND and how statins influence DIND.
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Affiliation(s)
- Jian Shen
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Kai-Yuan Huang
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Yu Zhu
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Jian-Wei Pan
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Hao Jiang
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Yu-Xiang Weng
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Ren-Ya Zhan
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
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40
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Turner CL, Budohoski K, Smith C, Hutchinson PJ, Kirkpatrick PJ, Murray GD. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial. Neurosurgery 2016; 77:786-92; discussion 792-3. [PMID: 26280117 PMCID: PMC4605277 DOI: 10.1227/neu.0000000000000963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury.
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Affiliation(s)
- Carole L Turner
- Academic Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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41
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Veldeman M, Höllig A, Clusmann H, Stevanovic A, Rossaint R, Coburn M. Delayed cerebral ischaemia prevention and treatment after aneurysmal subarachnoid haemorrhage: a systematic review. Br J Anaesth 2016; 117:17-40. [PMID: 27160932 DOI: 10.1093/bja/aew095] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED : The leading cause of morbidity and mortality after surviving the rupture of an intracranial aneurysm is delayed cerebral ischaemia (DCI). We present an update of recent literature on the current status of prevention and treatment strategies for DCI after aneurysmal subarachnoid haemorrhage. A systematic literature search of three databases (PubMed, ISI Web of Science, and Embase) was performed. Human clinical trials assessing treatment strategies, published in the last 5 yr, were included based on full-text analysis. Study data were extracted using tables depicting study type, sample size, and outcome variables. We identified 49 studies meeting our inclusion criteria. Clazosentan, magnesium, and simvastatin have been tested in large high-quality trials but failed to show a beneficial effect. Cilostazol, eicosapentaenoic acid, erythropoietin, heparin, and methylprednisolone yield promising results in smaller, non-randomized or retrospective studies and warrant further investigation. Topical application of nicardipine via implants after clipping has been shown to reduce clinical and angiographic vasospasm. Methods to improve subarachnoid blood clearance have been established, but their effect on outcome remains unclear. Haemodynamic management of DCI is evolving towards euvolaemic hypertension. Endovascular rescue therapies, such as percutaneous transluminal balloon angioplasty and intra-arterial spasmolysis, are able to resolve angiographic vasospasm, but their effect on outcome needs to be proved. Many novel therapies for preventing and treating DCI after aneurysmal subarachnoid haemorrhage have been assessed, with variable results. Limitations of the study designs often preclude definite statements. Current evidence does not support prophylactic use of clazosentan, magnesium, or simvastatin. Many strategies remain to be tested in larger randomized controlled trials. CLINICAL TRIAL REGISTRATION This systematic review was registered in the international prospective register of systematic reviews. PROSPERO CRD42015019817.
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Affiliation(s)
- M Veldeman
- Department of Neurosurgery Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | | | | | - A Stevanovic
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - R Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - M Coburn
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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42
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Kline AE, Leary JB, Radabaugh HL, Cheng JP, Bondi CO. Combination therapies for neurobehavioral and cognitive recovery after experimental traumatic brain injury: Is more better? Prog Neurobiol 2016; 142:45-67. [PMID: 27166858 DOI: 10.1016/j.pneurobio.2016.05.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 12/18/2022]
Abstract
Traumatic brain injury (TBI) is a significant health care crisis that affects two million individuals in the United Sates alone and over ten million worldwide each year. While numerous monotherapies have been evaluated and shown to be beneficial at the bench, similar results have not translated to the clinic. One reason for the lack of successful translation may be due to the fact that TBI is a heterogeneous disease that affects multiple mechanisms, thus requiring a therapeutic approach that can act on complementary, rather than single, targets. Hence, the use of combination therapies (i.e., polytherapy) has emerged as a viable approach. Stringent criteria, such as verification of each individual treatment plus the combination, a focus on behavioral outcome, and post-injury vs. pre-injury treatments, were employed to determine which studies were appropriate for review. The selection process resulted in 37 papers that fit the specifications. The review, which is the first to comprehensively assess the effects of combination therapies on behavioral outcomes after TBI, encompasses five broad categories (inflammation, oxidative stress, neurotransmitter dysregulation, neurotrophins, and stem cells, with and without rehabilitative therapies). Overall, the findings suggest that combination therapies can be more beneficial than monotherapies as indicated by 46% of the studies exhibiting an additive or synergistic positive effect versus on 19% reporting a negative interaction. These encouraging findings serve as an impetus for continued combination studies after TBI and ultimately for the development of successful clinically relevant therapies.
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Affiliation(s)
- Anthony E Kline
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States; Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States, United States; Psychology, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA 15213, United States.
| | - Jacob B Leary
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Hannah L Radabaugh
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Jeffrey P Cheng
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Corina O Bondi
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, United States; Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, United States
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Siler DA, Martini RP, Ward JP, Nelson JW, Borkar RN, Zuloaga KL, Liu JJ, Fairbanks SL, Raskin JS, Anderson VC, Dogan A, Wang RK, Alkayed NJ, Cetas JS. Protective role of p450 epoxyeicosanoids in subarachnoid hemorrhage. Neurocrit Care 2016; 22:306-19. [PMID: 25231529 DOI: 10.1007/s12028-014-0011-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients recovering from aneurysmal subarachnoid hemorrhage (SAH) are at risk for developing delayed cerebral ischemia (DCI). Experimental and human studies implicate the vasoconstrictor P450 eicosanoid 20-hydroxyeicosatetraenoic acid (20-HETE) in the pathogenesis of DCI. To date, no studies have evaluated the role of vasodilator epoxyeicosatrienoic acids (EETs) in DCI. METHODS Using mass spectrometry, we measured P450 eicosanoids in cerebrospinal fluid (CSF) from 34 SAH patients from 1 to 14 days after admission. CSF eicosanoid levels were compared in patients who experienced DCI versus those who did not. We then studied the effect of EETs in a model of SAH using mice lacking the enzyme soluble epoxide hydrolase (sEH), which catabolizes EETs into their inactive diol. To assess changes in vessel morphology and cortical perfusion in the mouse brain, we used optical microangiography, a non-invasive coherence-based imaging technique. RESULTS Along with increases in 20-HETE, we found that CSF levels of 14,15-EET were elevated in SAH patients compared to control CSF, and levels were significantly higher in patients who experienced DCI compared to those who did not. Mice lacking sEH had elevated 14,15-EET and were protected from the delayed decrease in microvascular cortical perfusion after SAH, compared to wild type mice. CONCLUSIONS Our findings suggest that P450 eicosanoids play an important role in the pathogenesis of DCI. While 20-HETE may contribute to the development of DCI, 14,15-EET may afford protection against DCI. Strategies to enhance 14,15-EET, including sEH inhibition, should be considered as part of a comprehensive approach to prevent DCI.
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Affiliation(s)
- Dominic A Siler
- Department of Anesthesiology & Perioperative Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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Iqbal S, Hayman EG, Hong C, Stokum JA, Kurland DB, Gerzanich V, Simard JM. Inducible nitric oxide synthase (NOS-2) in subarachnoid hemorrhage: Regulatory mechanisms and therapeutic implications. Brain Circ 2016; 2:8-19. [PMID: 27774520 PMCID: PMC5074544 DOI: 10.4103/2394-8108.178541] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) typically carries a poor prognosis. Growing evidence indicates that overabundant production of nitric oxide (NO) may be responsible for a large part of the secondary injury that follows SAH. Although SAH modulates the activity of all three isoforms of nitric oxide synthase (NOS), the inducible isoform, NOS-2, accounts for a majority of NO-mediated secondary injuries after SAH. Here, we review the indispensable physiological roles of NO that must be preserved, even while attempting to downmodulate the pathophysiologic effects of NO that are induced by SAH. We examine the effects of SAH on the function of the various NOS isoforms, with a particular focus on the pathological effects of NOS-2 and on the mechanisms responsible for its transcriptional upregulation. Finally, we review interventions to block NOS-2 upregulation or to counteract its effects, with an emphasis on the potential therapeutic strategies to improve outcomes in patients afflicted with SAH. There is still much to be learned regarding the apparently maladaptive response of NOS-2 and its harmful product NO in SAH. However, the available evidence points to crucial effects that, on balance, are adverse, making the NOS-2/NO/peroxynitrite axis an attractive therapeutic target in SAH.
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Affiliation(s)
- Sana Iqbal
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Erik G Hayman
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Caron Hong
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Jesse A Stokum
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - David B Kurland
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Volodymyr Gerzanich
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - J Marc Simard
- Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA; Department of Pathology, School of Medicine, University of Maryland, Baltimore, Maryland, USA; Department of Physiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Experimental animal models and inflammatory cellular changes in cerebral ischemic and hemorrhagic stroke. Neurosci Bull 2015; 31:717-34. [PMID: 26625873 DOI: 10.1007/s12264-015-1567-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/25/2015] [Indexed: 01/04/2023] Open
Abstract
Stroke, including cerebral ischemia, intracerebral hemorrhage, and subarachnoid hemorrhage, is the leading cause of long-term disability and death worldwide. Animal models have greatly contributed to our understanding of the risk factors and the pathophysiology of stroke, as well as the development of therapeutic strategies for its treatment. Further development and investigation of experimental models, however, are needed to elucidate the pathogenesis of stroke and to enhance and expand novel therapeutic targets. In this article, we provide an overview of the characteristics of commonly-used animal models of stroke and focus on the inflammatory responses to cerebral stroke, which may provide insights into a framework for developing effective therapies for stroke in humans.
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Du R, Zhou J, Lorenzano S, Liu W, Charoenvimolphan N, Qian B, Xu J, Wang J, Zhang X, Wang X, Berndt A, Devan WJ, Valant VJ, Wang J, Furie KL, Rosand J, Rost N, Friedlander RM, Paigen B, Weiss ST. Integrative Mouse and Human Studies Implicate ANGPT1 and ZBTB7C as Susceptibility Genes to Ischemic Injury. Stroke 2015; 46:3514-22. [PMID: 26542693 DOI: 10.1161/strokeaha.115.010767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/01/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The extent of ischemic injury in response to cerebral ischemia is known to be affected by native vasculature. However, the nonvascular and dynamic vascular responses and their genetic basis are not well understood. METHODS We performed a genome-wide association study in 235 mice from 33 inbred strains using the middle cerebral artery occlusion model. Population structure and genetic relatedness were accounted for using the efficient mixed-model association method. Human orthologs to the genes associated with the significant and suggestive single-nucleotide polymorphisms from the mouse strain survey were examined in patients with M1 occlusions admitted with signs and symptoms of acute ischemic stroke. RESULTS We identified 4 genome-wide significant and suggestive single-nucleotide polymorphisms to be associated with infarct volume in mice (rs3694965, P=2.17×10(-7); rs31924033, P=5.61×10(-6); rs32249495, P=2.08×10(-7); and rs3677406, P=9.56×10(-6)). rs32249495, which corresponds to angiopoietin-1 (ANGPT1), was also significant in the recessive model in humans, whereas rs1944577, which corresponds to ZBTB7C, was nominally significant in both the additive and dominant genetic models in humans. ZBTB7C was shown to be upregulated in endothelial cells using both in vitro and in vivo models of ischemia. CONCLUSIONS Genetic variations of ANGPT1 and ZBTB7C are associated with increased infarct size in both mice and humans. ZBTB7C may modulate the ischemic response via neuronal apoptosis and dynamic collateralization and, in addition to ANGPT1, may serve as potential novel targets for treatments of cerebral ischemia.
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Affiliation(s)
- Rose Du
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.).
| | - Jing Zhou
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Svetlana Lorenzano
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Wenming Liu
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Nareerat Charoenvimolphan
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Baogang Qian
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Jun Xu
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Jian Wang
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Xinmu Zhang
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Xin Wang
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Annerose Berndt
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - William J Devan
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Valerie J Valant
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Jinyi Wang
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Karen L Furie
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Jonathan Rosand
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Natalia Rost
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Robert M Friedlander
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Beverly Paigen
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Scott T Weiss
- From the Department of Neurosurgery (R.D., J.Z., W.L., N.C., B.Q., J.X., J.W., X.Z., X.W.) and Channing Division of Network Medicine, Department of Medicine (R.D., S.T.W.), Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston (S.L., W.J.D., V.J.V., J.R., N.R.); Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy (S.L.); Department of Chemical Biology, Northwest Agriculture and Forestry University, Shaanxi, People's Republic of China (W.L., J.W.); Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, People's Republic of China (J.X.); The Jackson Laboratory, Bar Harbor, ME (A.B., B.P.); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine (A.B.) and Department of Neurosurgery (R.M.F.), University of Pittsburgh School of Medicine, PA; Quinnipiac University Frank H. Netter, MD School of Medicine, Hamden, CT (W.J.D.); University of Massachusetts Medical School, Worcester (V.J.V.); and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
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Wong GK, Wong A, Zee BC, Poon WS, Chan MT, Gin T, Siu DY, Mok VC. Cognitive outcome in acute simvastatin treatment for aneurysmal subarachnoid hemorrhage: A propensity matched analysis. J Neurol Sci 2015; 358:58-61. [DOI: 10.1016/j.jns.2015.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
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Woo SW, Kim JH, Kang HI, Kim DR, Moon BG, Kim JS. High-Dose Simvastatin Is Effective in Preventing Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study in Korean Patients. J Korean Neurosurg Soc 2015; 58:328-33. [PMID: 26587185 PMCID: PMC4651992 DOI: 10.3340/jkns.2015.58.4.328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 11/27/2022] Open
Abstract
Objective The goal of this study was to assess the effect of high-dose simvastatin on cerebral vasospasm and its clinical outcome after aneurysmal subarachnoid hemorrhage (SAH) in Korean patients. Methods This study was designed as a prospective observational cohort study. Its subjects were aneurysmal SAH patients who had undergone aneurysm clipping or coiling. They were assigned to 1 of 3 groups : the 20 mg, 40 mg, and 80 mg simvastatin groups. The primary end-point was the occurrence of symptomatic vasospasm. The clinical outcome was assessed with the modified Rankin Scale (mRS) score after 1 month and 3 months. The risk factors of the development of vasospasm were assessed by logistic regression analysis. Results Ninety nine patients with aneurysmal SAH were treated and screened. They were sequentially assigned to the 20 mg (n=22), 40 mg (n=34), and 80 mg (n=31) simvastatin groups. Symptomatic vasospasm occurred in 36.4% of the 20 mg group, 8.8% of the 40 mg group, and 3.2% of the 80 mg group (p=0.003). The multiple logistic regression analysis showed that poor Hunt-Hess grades (OR=5.4 and 95% CI=1.09-26.62) and high-dose (80 mg) simvastatin (OR=0.09 and 95% CI=0.1-0.85) were independent factors of symptomatic vasospasm. The clinical outcomes did not show a significant difference among the three groups. Conclusion This study demonstrated that 80 mg simvastatin treatment was effective in preventing cerebral vasospasm after aneurysmal SAH, but did not improve the clinical outcome in Korean patients.
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Affiliation(s)
- Sung Woong Woo
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Hee In Kang
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Deok Ryeong Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Byung Gwan Moon
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Joo Seung Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
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Donnelly J, Aries MJ, Czosnyka M. Further understanding of cerebral autoregulation at the bedside: possible implications for future therapy. Expert Rev Neurother 2015; 15:169-85. [PMID: 25614952 DOI: 10.1586/14737175.2015.996552] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral autoregulation reflects the ability of the brain to keep the cerebral blood flow (CBF) relatively constant despite changes in cerebral perfusion pressure. It is an intrinsic neuroprotective physiological phenomenon often suggested as part of pathophysiological pathways in brain research. However, despite increasing knowledge of this phenomenon for over 50 years, harnessing cerebral autoregulation as a basis for therapy remains an elegant concept rather than a practical reality. This raises the question is it useful to measure at the bedside or is it merely a scientific curiosity that is too complex and has little pragmatic relevance. In this article, we attempt to answer this question by demonstrating how cerebral autoregulation assessment can have prognostic value, indicate pathological states, and potentially even influence therapy with the use of the 'optimal cerebral perfusion pressure' paradigm. Evidence from the literature is combined with bedside clinical examples to address the following fundamental questions about cerebral autoregulation: What is it? How do we measure it? Why is it important? Can we use it as a basis for therapy?
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Affiliation(s)
- Joseph Donnelly
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
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Increased ICP promotes CaMKII-mediated phosphorylation of neuronal NOS at Ser⁸⁴⁷ in the hippocampus immediately after subarachnoid hemorrhage. Brain Res 2015; 1616:19-25. [PMID: 25940762 DOI: 10.1016/j.brainres.2015.04.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/13/2015] [Accepted: 04/24/2015] [Indexed: 01/08/2023]
Abstract
Early brain injury has recently been identified as an indicator of poor prognosis after subarachnoid hemorrhage (SAH). Calmodulin-dependent protein kinase IIα (CaMKIIα) has been shown to phosphorylate neuronal NOS (nNOS) at Ser(847), resulting in a reduction in nNOS activity. In this study, we revealed chronological changes in the phosphorylation of nNOS at Ser(847) in the hippocampus and cortex immediately after SAH. In a rat single-hemorrhage model of SAH, the hippocampus and adjacent cortex were collected up to 24h after SAH. Samples from rats that were not injected with blood were used as controls. NOS was partially purified from the crude samples using ADP-agarose affinity chromatography. Western blot analysis revealed that nNOS phosphorylated (p-nNOS) at Ser(847) was significantly increased in the hippocampus, but not in the cortex, at 1h after SAH compared with that resulting from the control treatment. Immunoreactivity of p-nNOS at Ser(847) was observed in interneurons of the hippocampus at 1h after SAH. Injection of saline instead of blood also significantly induced p-nNOS at Ser(847) levels in the hippocampus at 1h after injection. The colocalization of CaMKIIα and nNOS was transiently increased in the hippocampus at 0.5h after SAH. Our data suggest that immediately after SAH, an increase in intracranial pressure might induce transient cerebral ischemia, potentially promoting the phosphorylation of nNOS at Ser(847) by CaMKIIα in the hippocampus. The activation of p-nNOS at Ser(847) in the hippocampus may alleviate ischemic insults immediately after SAH to exert a neuroprotective effect against early brain injury.
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