Protein kinase C has two different major roles in lattice compaction enhanced by cerebrospinal fluid from patients with subarachnoid hemorrhage

Development and validation of a nomogram to predict the probability of death after surgical evacuation for traumatic intracranial hemorrhage

Here we describe the derivation and validation of a prognostic nomogram for patients with Traumatic Intracranial Hemorrhage (tICH) after surgical evacuation. This is a retrospective study based on 245 patients admitted to the Department of Neurosurgery of Huashan Hospital affiliated to Fudan University, between August 2005, and August 2023. We divided the dataset into primary and validation data by the ratio of 7:3. The LASSO regression model was used for predictor selection. The nomogram was developed using Cox regression models. The predictive performance of the nomogram was assessed by concordance index (C index) and calibration in the primary and validation cohorts. We also used decision curve analysis (DCA) to describe the clinical value. The main outcome was death related to tICH. The nomogram incorporated age, GCS-E, history of hypertension, and cerebellar hematoma, which was selected by the LASSO regression model. The nomogram showed good calibration and discrimination in the primary and validation data, with a 1-year C-index of 0.882 (95% CI, 0.777 to 0.987) and 0.818 (95% CI, 0.669 to 0.968), respectively. Decision curve analysis indicated that the nomogram is clinically useful when the patient or doctor's threshold probability ranges from 10 to 100%. In this study, we found that the tICH-related mortality rate was 11.42% (28/245). In the elderly cohort aged ≥ 65 years, the mortality rate increased to 28.13%(18/64). The nomogram we developed here can be conveniently used to predict the long-term prognosis of patients with tICH after surgical evacuation.Retrospectively registered: KY2024-860.

Vascular smooth muscle function: The physiology and pathology of vasoconstriction

Vascular smooth muscle is the contractile component of arteries and veins. The control of contraction and relaxation is dependent upon intracellular and extracellular signals. Abnormal contractions can cause and or contribute to pathology such as hypertension, ischemia and infarction. In this review, we address the vascular pathogenesis associated with hypertension and subarachnoid hemorrhage induced cerebral vasospasm. Hypertension is a multifactorial disease with many causes and a profound impact on the cardiovascular system, whereas subarachnoid hemorrhage induced cerebral vasospasm is a pathological vasoconstriction often causing infarction that is thought to be 'caused' by a factor or factors in the CSF following the hemorrhage. However, the mechanism by which the vessels are constricted is unknown. Although the causes for these two pathological vasoconstrictions remain to be determined, we conclude that the common denominator is that these contractile changes result in pathology with devastating consequences to human health.

Protein Kinase C Activates Human Lipocalin-type Prostaglandin D Synthase Gene Expression through De-repression of Notch-HES Signaling and Enhancement of AP-2β Function in Brain-derived TE671 Cells

Here we investigated the regulatory mechanism of lipocalin-type prostaglandin D synthase (L-PGDS) gene expression in human TE671 (medulloblastoma of cerebellum) cells. Reporter analysis of the promoter region from -730 to +75 of the human L-PGDS gene demonstrated that deletion or mutation of the N-box at -337 increased the promoter activity 220-300%. The N-box was bound by Hes-1, a mammalian homologue of Drosophila Hairy and enhancer of split, as examined by electrophoretic mobility shift assay and chromatin immunoprecipitation assay. Functional expression of the Notch intracellular domain significantly increased Hes-1 expression and decreased L-PGDS expression level in TE671 cells. Moreover, knock-down of Hes-1 mRNA by RNA interference significantly enhanced the L-PGDS mRNA level, indicating that the L-PGDS gene expression is repressed by the Notch-Hes signaling. When the AP-2 element at -98 of the promoter region was deleted or mutated, the promoter activity was drastically decreased to approximately 10% of normal. The AP-2 element was bound by AP-2beta dominantly expressed in TE671 cells, according to the results of electrophoretic mobility shift assay and chromatin immunoprecipitation assay. L-PGDS expression was induced by 12-O-tetradecanoylphorbol-13-acetate in TE671 cells, and this induction was inhibited by a protein kinase C inhibitor. Stimulation of TE671 cells with 12-O-tetradecanoylphorbol-13-acetate or transfection with protein kinase Calpha expression vector induced phosphorylation of Hes-1, inhibition of DNA binding of Hes-1 to the N-box, and activation of the AP-2beta function to up-regulate L-PGDS gene expression. These results reveal a novel transcriptional regulatory mechanism responsible for the high level expression of the human L-PGDS gene in TE671 cells.

Integrin-Linked Kinase: A Possible Role in Scar Contracture

Integrin-linked kinase (ILK) participates with beta1 integrin to mediate extracellular matrix interactions, such as extracellular matrix reorganization. Thus, ILK is hypothesized to influence wound contraction and scar contracture and, as such, would be a target molecule to manipulate pharmacologically in expediting wound contraction or possibly preventing scar contracture. The expression of ILK messenger ribonucleic acid, along with ILK-protein expression, was found in fibroblasts. The localization of ILK in human skin and rat granulation tissue was documented by immunohistology. ILK was present in human dermal fibroblasts, but was not found in human epidermal cells in skin. Cells were transfected with wild-type ILK or kinase-deficient ILK (E359K) and were assayed for collagen lattice contraction, migration, and myosin adenosine triphosphatase (ATPase) activity. Cells overexpressing E359K were poorer at collagen lattice contraction than control cells, whereas cells overexpressing wild-type ILK were equal to control cells at lattice contraction. ILK overexpression enhanced cell migration, but E359K overexpression did not affect cell migration. Neither ILK nor E359K overexpression altered myosin ATPase activity. Hence, ILK action within fibroblasts appears unrelated to myosin ATPase control of microfilament-generated forces. ILK appears to be a target molecule for pharmacologic manipulation to expedite wound contraction or to prevent scar contracture.

Role of tyrosine kinase in fibroblast compaction and cerebral vasospasm

Hemolysate, a proposed causative agent for cerebral vasospasm following subarachnoid hemorrhage, produces contraction of cerebral arteries by activation of tyrosine kinases. In addition, hemolysate accelerates fibroblast collagen compaction that could play a role in cerebral vasospasm. We studied the effect of hemolysate on tyrosine phosphorylation and fibroblast collagen compaction in cultured dog cerebral and human dermal fibroblasts using tyrosine kinase inhibitors and tyrosine antibodies (Western blot). 1) Hemolysate was found to enhance tyrosine phosphorylation of two proteins approximately 64 and 120 kDa. The effect of hemolysate was time- and concentration-dependent. 2) Two main components in hemolysate, oxyhemoglobin and adenosine triphosphate (ATP), produced similar results to that of hemolysate. 3) Tyrosine kinase inhibitor genistein and tyrphostin A51 (30 microM) markedly reduced the effect of hemolysate on tyrosine phosphorylation. 4) In another study, hemolysate increased fibroblast collagen compaction and the effect of hemolysate was reduced by genistein and tyrphostin A51. We conclude that hemolysate activates tyrosine kinase that may lead to acceleration of fibroblast compaction. This effect of hemolysate may contribute to cerebral vasospasm.

Mechanism of hemolysate-induced [Ca2+]i elevation in cultured fibroblasts

Erythrocyte lysate (hemolysate) released from blood clot after subarachnoid hemorrhage is the causative agent for chronic cerebral vasospasm, a prolonged contraction of cerebral arteries. Fibroblasts, the outer layer cells of vessel wall that in contact with blood clot directly, may contribute to cerebral vasospasm. However, the effect of hemolysate on intracellular Ca2+ ([Ca2+]i) mobilization in fibroblasts has not been studied. We investigated hemolysate-induced [Ca2+]i mobilization in cultured neonatal human dermal and canine middle cerebral arterial fibroblasts by using fura-2 microfluorimetry. Hemolysate increased [Ca2+]i by releasing internal Ca2+ stores and promoting Ca2+ entry. Tyrosine kinase inhibitors partially but significantly reduced the effect of hemolysate. The major components of hemolysate, oxyhemoglobin (OxyHb) and adenosine triphosphate (ATP) failed to mimic the effect of hemolysate. In cultured canine middle cerebral arterial fibroblasts, hemolysate produced similar Ca2+ mobilization to that of dermal cells. OxyHb and ATP failed again to reproduce the effect of hemolysate. We conclude that hemolysate increases [Ca2+]i in fibroblasts and this effect of hemolysate is not mediated by OxyHb or ATP but by some unknown factors.

The presence of an extractable substance in the CSF of humans with cerebral vasospasm after subarachnoid haemorrhage that correlates with phosphatase inhibition

The cellular events leading to cerebral vasospasm after subarachnoid haemorrhage are poorly understood, although an increase in smooth muscle myosin light chain phosphorylation has been observed. This study set out to determine if phosphatase inhibition may be involved in the pathological maintenance of tension observed during vasospasm. We found that 1 nM okadaic acid, a type 2A protein phosphatase inhibitor, elicited an increase in rate of O(2) consumption in the porcine carotid artery similar to that by cerebrospinal fluid (CSF) from vasospastic patients (CSF(V), n=5) (control 0.23+/-0.03, CSF(V) 0.84+/-0.16 and okadaic acid 0.85+/-0.02 micromol min(-1) g dwt(-1)). It was also observed that phosphatase inhibition with 1 nM okadaic acid significantly slowed relaxation after a stretch in a similar fashion to CSF(V) haemorrhage. CSF from vasospastic subarachnoid haemorrhage patients, but not from those without vasospasm, contains an extractable substance which modulates myosin light chain phosphorylation in vitro. A phosphatase preparation obtained from the porcine carotid artery dephosphorylated 63+/-2% of the phosphorylated (MLC(20)) substrate in vitro, and non-vasospastic CSF treated enzyme dephosphorylated 60+/-2.6%. Okadaic acid inhibited phosphatase dephosphorylated only 7.5+/-1% of the substrate where CSF(V) treated enzyme dephosphorylated 22+/-2.8% of the substrate. We conclude that inhibition of smooth muscle phosphatase may be involved in the mechanisms associated with cerebral vasospasm after subarachnoid haemorrhage.

Hemolysate induces tyrosine phosphorylation and collagen-lattice compaction in cultured fibroblasts

Hemolysate, a proposed causative agent for cerebral vasospasm after subarachnoid hemorrhage, produces contraction of cerebral arteries by activation of tyrosine kinases. In addition, hemolysate increases fibroblast-collagen compaction that could play a role in cerebral vasospasm. We studied the effect of hemolysate on tyrosine phosphorylation and fibroblast-collagen compaction in cultured canine basilar and human dermal fibroblasts using tyrosine kinase inhibitors and tyrosine antibodies. Hemolysate enhanced tyrosine phosphorylation of two proteins, 64 and 120 kDa, in cultured canine basilar artery and human dermal fibroblast cells. The effect of hemolysate was time-dependent and concentration-dependent. Oxyhemoglobin and ATP, the two major components of hemolysate, produced similar tyrosine phosphorylation, however, with a different time course. Tyrosine kinase inhibitors genistein and tyrphostin A51 abolished the effect of hemolysate in both cerebral and dermal fibroblasts. Hemolysate increased fibroblast-populated collagen-lattice compaction and tyrosine kinase inhibitors genistein and tyrphostin A51 attenuated the effect of hemolysate. We conclude that hemolysate activates tyrosine kinase that leads to the increase of fibroblast compaction. This effect of hemolysate may contribute to cerebral vasospasm.

Accentuated Vasospasm during Treatment of an Acutely Ruptured Aneurysm with Electrolytically Detachable Coils: Coincidence or Causation?

We report an unusual case of precipitous worsening of vasospasm associated with subarachnoid haemorrhage that developed during endosaccular coil embolisation of a ruptured posterior communicating aneurysm. The acutely worsening vasospasm occurred in the distal ipsilateral anterior circulation remote from the site of microcatheter manipulation, resulting in transient occlusion. Despite successful endovascular treatment of both the aneurysm and vasospasm, the patient continued to clinically decline and eventually died. This case raises important issues regarding the potential mechanisms and optimal therapeutic strategies for this complication, which are reviewed.

Subarachnoid haemorrhage: what happens to the cerebral arteries?

1. Subarachnoid haemorrhage (SAH) is a unique disorder and a major clinical problem that most commonly occurs when an aneurysm in a cerebral artery ruptures, leading to bleeding and clot formation. Subarachnoid haemorrhage results in death or severe disability of 50-70% of victims and is the cause of up to 10% of all strokes. Delayed cerebral vasospasm, which is the most critical clinical complication that occurs after SAH, seems to be associated with both impaired dilator and increased constrictor mechanisms in cerebral arteries. Mechanisms contributing to development of vasospasm and abnormal reactivity of cerebral arteries after SAH have been intensively investigated in recent years. In the present review we focus on recent advances in our knowledge of the roles of nitric oxide (NO) and cGMP, endothelin (ET), protein kinase C (PKC) and potassium channels as they relate to SAH. 2. Nitric oxide is produced by the endothelium and is an important regulator of cerebral vascular tone by tonically maintaining the vasculature in a dilated state. Endothelial injury after SAH may interfere with NO production and lead to vasoconstriction and impaired responses to endothelium-dependent vasodilators. Inactivation of NO by oxyhaemoglobin or superoxide from erythrocytes may also occur in the subarachnoid space after SAH. 3. Nitric oxide stimulates activity of soluble guanylate cyclase in vascular muscle, leading to intracellular generation of cGMP and relaxation. Subarachnoid haemorrhage appears to cause impaired activity of soluble guanylate cyclase, resulting in reduced basal levels of cGMP in cerebral vessels and often decreased responsiveness of cerebral arteries to NO. 4. Endothelin is a potent, long-lasting vasoconstrictor that may contribute to the spasm of cerebral arteries after SAH. Endothelin is present in increased levels in the cerebrospinal fluid of SAH patients. Pharmacological inhibition of ET synthesis or of ET receptors has been reported to attenuate cerebral vasospasm. Production of and vasoconstriction by ET may be due, in part, to the decreased activity of NO and formation of cGMP. 5. Protein kinase C is an important enzyme involved in the contraction of vascular muscle in response to several agonists, including ET. Activity of PKC appears to be increased in cerebral arteries after SAH, indicating that PKC may be critical in the development of cerebral vasospasm. Recent evidence suggests that PKC activation may occur in cerebral arteries after SAH as a result of decreased negative feedback influence of NO/cGMP. 6. Cerebral arteries are depolarized after SAH, possibly due to decreased activity of potassium channels in vascular muscle. Decreased basal activation of potassium channels may be due to several mechanisms, including impaired activity of NO (and/or cGMP) or increased activity of PKC. Vasodilator drugs that produce hyperpolarization, such as potassium channel openers, appear to be unusually effective in cerebral arteries after SAH. 7. Thus, endothelial damage and reduced activity of NO may contribute to cerebral vascular dysfunction after SAH. Potassium channels may represent an important therapeutic target for the treatment of cerebral vasospasm after SAH.