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He W, Zhang Z, Sha X. Nanoparticles-mediated emerging approaches for effective treatment of ischemic stroke. Biomaterials 2021; 277:121111. [PMID: 34488117 DOI: 10.1016/j.biomaterials.2021.121111] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
Ischemic stroke leads to high disability and mortality. The limited delivery efficiency of most therapeutic substances is a major challenge for effective treatment of ischemic stroke. Inspired by the prominent merit of nanoscale particles in brain targeting and blood-brain barrier (BBB) penetration, various functional nanoparticles have been designed as promising drug delivery platforms that are expected to improve the therapeutic effect of ischemic stroke. Based on the complex pathological mechanisms of ischemic stroke, this review outline and summarize the rationally designed nanoparticles-mediated emerging approaches for effective treatment of ischemic stroke, including recanalization therapy, neuroprotection therapy, and combination therapy. On this bases, the potentials and challenges of nanoparticles in the treatment of ischemic stroke are revealed, and new thoughts and perspectives are proposed for the design of feasible nanoparticles for effective treatment of ischemic stroke.
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Affiliation(s)
- Wenxiu He
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Zhiwen Zhang
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Xianyi Sha
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University, Shanghai, 201203, China; The Institutes of Integrative Medicine of Fudan University, 120 Urumqi Middle Road, Shanghai, 200040, China.
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Mini-review: Perfluorocarbons, Oxygen Transport, and Microcirculation in Low Flow States: in Vivo and in Vitro Studies. Shock 2020; 52:19-27. [PMID: 28930919 DOI: 10.1097/shk.0000000000000994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The in vivo study of microvascular oxygen transport requires accurate and challenging measurements of several mass transfer parameters. Although recommended, blood flow and oxygenation are typically not measured in many studies where treatments for ischemia are tested. Therefore, the aim of this communication is to briefly review cardinal aspects of oxygen transport, and the effects of perfluorocarbon (PFC) treatment on blood flow and oxygenation based mostly on studies performed in our laboratory. As physiologically relevant events in oxygen transport take place at the microvascular level, we implemented the phosphorescence quenching technique coupled with noninvasive intravital videomicroscopy for quantitative evaluation of these events in vivo. Rodent experimental models and various approaches have been used to induce ischemia, including hemorrhage, micro- and macroembolism, and microvessel occlusion. Measurements show decrease in microvascular blood flow as well as intravascular and tissue oxygen partial pressure (PO2) after these procedures. To minimize or reverse the effects of ischemia and hypoxia, artificial oxygen carriers such as different PFCs were tested. Well-defined endpoints such as blood flow and tissue PO2 were measured because they have significant effect on tissue survival and outcome. In several cases, enhancement of flow and oxygenation could be demonstrated. Similar results were found in vitro: PFC emulsion mixed with blood (from healthy donors and sickle cell disease patients) enhanced oxygen transport. In summary, PFCs may provide beneficial effects in these models by mechanisms at the microvascular level including facilitated diffusion and bubble reabsorption leading to improved blood flow and oxygenation.
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Baron JC. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat Rev Neurol 2019; 14:325-337. [PMID: 29674752 DOI: 10.1038/s41582-018-0002-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization. Novel therapies aiming to 'freeze' the penumbra - that is, prevent core growth until recanalization is complete - hold potential as adjuncts to mechanical thrombectomy. This Review focuses on nonpharmacological approaches that aim to restore the physiological balance between oxygen delivery to and oxygen demand of the penumbra. Particular emphasis is placed on normobaric oxygen therapy, hypothermia and sensory stimulation. Preclinical evidence and early pilot clinical trials are critically reviewed, and future directions, including clinical translation and trial design issues, are discussed.
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Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université Paris 5, INSERM U894, Paris, France.
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Deuchar GA, van Kralingen JC, Work LM, Santosh C, Muir KW, McCabe C, Macrae IM. Preclinical Validation of the Therapeutic Potential of Glasgow Oxygen Level Dependent (GOLD) Technology: a Theranostic for Acute Stroke. Transl Stroke Res 2018; 10:583-595. [PMID: 30506268 PMCID: PMC6733820 DOI: 10.1007/s12975-018-0679-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022]
Abstract
In acute stroke patients, penumbral tissue is non-functioning but potentially salvageable within a time window of variable duration and represents target tissue for rescue. Reperfusion by thrombolysis and/or thrombectomy can rescue penumbra and improve stroke outcomes, but these treatments are currently available to a minority of patients. In addition to the utility of Glasgow Oxygen Level Dependent (GOLD) as an MRI contrast capable of detecting penumbra, its constituent perfluorocarbon (PFC) oxygen carrier, combined with normobaric hyperoxia, also represents a potential acute stroke treatment through improved oxygen delivery to penumbra. Preclinical studies were designed to test the efficacy of an intravenous oxygen carrier, the perfluorocarbon emulsion Oxycyte® (O-PFC), combined with normobaric hyperoxia (50% O2) in both in vitro (neuronal cell culture) and in vivo rat models of ischaemic stroke. Outcome was assessed through the quantification of lipid peroxidation and oxidative stress levels, mortality, infarct volume, neurological scoring and sensorimotor tests of functional outcome in two in vivo models of stroke. Additionally, we investigated evidence for any positive or negative interactions with the thrombolytic recombinant tissue plasminogen activator (rt-PA) following embolus-induced stroke in rats. Treatment with intravenous O-PFC + normobaric hyperoxia (50% O2) provided evidence of reduced infarct size and improved functional recovery. It did not exacerbate oxidative stress and showed no adverse interactions with rt-PA. The positive results and lack of adverse effects support human trials of O-PFC + 50% O2 normobaric hyperoxia as a potential therapeutic approach. Combined with the diagnostic data presented in the preceding paper, O-PFC and normobaric hyperoxia is a potential theranostic for acute ischaemic stroke.
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Affiliation(s)
- Graeme A Deuchar
- Aurum Biosciences Ltd, 20-23 Woodside Place, Glasgow, Scotland, G3 7QL, UK.
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
| | - Josie C van Kralingen
- Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Lorraine M Work
- Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Celestine Santosh
- Aurum Biosciences Ltd, 20-23 Woodside Place, Glasgow, Scotland, G3 7QL, UK
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, G51 4TF, UK
| | - Keith W Muir
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, G51 4TF, UK
| | - Chris McCabe
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - I Mhairi Macrae
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
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Enhancement of bradykinin-induced relaxation by focal brain ischemia in the rat middle cerebral artery: Receptor expression upregulation and activation of multiple pathways. PLoS One 2018; 13:e0198553. [PMID: 29912902 PMCID: PMC6005516 DOI: 10.1371/journal.pone.0198553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/21/2018] [Indexed: 01/06/2023] Open
Abstract
Focal brain ischemia markedly affects cerebrovascular reactivity. So far, these changes have mainly been related to alterations in the level of smooth muscle cell function while alterations of the endothelial lining have not yet been studied in detail. We have, therefore, investigated the effects of ischemia/reperfusion injury on bradykinin (BK)-induced relaxation since BK is an important mediator of tissue inflammation and affects vascular function in an endothelium-dependent manner. Focal brain ischemia was induced in rats by endovascular filament occlusion (2h) of the middle cerebral artery (MCA). After 22h reperfusion, both MCAs were harvested and the response to BK studied in organ bath experiments. Expression of the BK receptor subtypes 1 and 2 (B1, B2) was determined by real-time semi-quantitative RT-qPCR methodology, and whole mount immunofluorescence staining was performed to show the B2 receptor protein expression. In control animals, BK did not induce significant vasomotor effects despite a functionally intact endothelium and robust expression of B2 mRNA. After ischemia/reperfusion injury, BK induced a concentration-related sustained relaxation in all arteries studied, more pronounced in the ipsilateral than in the contralateral MCA. The B2 mRNA was significantly upregulated and the B1 mRNA displayed de novo expression, again more pronounced ipsi- than contralaterally. Endothelial cells displaying B2 receptor immunofluorescence were observed scattered or clustered in previously occluded MCAs. Relaxation to BK was mediated by B2 receptor activation, abolished after endothelium denudation, and largely diminished by blocking nitric oxide (NO) release or soluble guanylyl cyclase activity. Relaxation to BK was partially inhibited by charybdotoxin (ChTx), but not apamin or iberiotoxin suggesting activation of an endothelium-dependent hyperpolarization pathway. When the NO-cGMP pathway was blocked, BK induced a transient relaxation which was suppressed by ChTx. After ischemia/reperfusion injury BK elicits endothelium-dependent relaxation which was not detectable in control MCAs. This gain of function is mediated by B2 receptor activation and involves the release of NO and activation of an endothelium-dependent hyperpolarization. It goes along with increased B2 mRNA and protein expression, leaving the functional role of the de novo B1 receptor expression still open.
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Abutarboush R, Mullah SH, Saha BK, Haque A, Walker PB, Aligbe C, Pappas G, Tran Ho LTV, Arnaud FG, Auker CR, McCarron RM, Scultetus AH, Moon-Massat P. Brain oxygenation with a non-vasoactive perfluorocarbon emulsion in a rat model of traumatic brain injury. Microcirculation 2018; 25:e12441. [DOI: 10.1111/micc.12441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Rania Abutarboush
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Saad H. Mullah
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Biswajit K. Saha
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Ashraful Haque
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Peter B. Walker
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Chioma Aligbe
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Georgina Pappas
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | | | - Francoise G. Arnaud
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Charles R. Auker
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Richard M. McCarron
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Anke H. Scultetus
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Paula Moon-Massat
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
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Shanbhag NC, Henning RH, Schilling L. Long-term survival in permanent middle cerebral artery occlusion: a model of malignant stroke in rats. Sci Rep 2016; 6:28401. [PMID: 27329690 PMCID: PMC4916503 DOI: 10.1038/srep28401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/01/2016] [Indexed: 12/29/2022] Open
Abstract
Occlusion of the middle cerebral artery (MCA) by an intraluminal filament is widely used to study focal brain ischemia in male Sprague-Dawley rats. However, permanent occlusion goes along with a high fatality. To overcome this drawback we designed a new filament carrying a bowling pin-shaped tip (BP-tip) and compared this with three conventionally tipped filaments. Follow-up periods were 24 h (all groups) and 72 and 120 h in BP-tip group. Ischemic damage and swelling were quantified using silver nitrate staining. Collateral flow via the posterior cerebral artery (PCA) was assessed using selective dye perfusion of the internal carotid artery. Despite a comparable decrease of brain perfusion in all groups, ischemic damage was significantly smaller in BP-tips (p < 0.05). Moreover, BP-tip significantly reduced mortality from 60% to 12.5% and widely spared the occipital region and hypothalamus from ischemic damage. Conventional but not BP-tip filaments induced vascular distortion, measured as gross displacement of the MCA origin, which correlated with occipital infarction size. Accordingly, BP-tip occluded rats showed a significantly better collateral filling of the PCA territory. Ischemic volume significantly increased in BP-tip occlusion at 72 h follow-up. BP-tip filaments offer superior survival in permanent MCA occlusion, while mimicking the course of a malignant stroke in patients.
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Affiliation(s)
- Nagesh C Shanbhag
- Division of Neurosurgical Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, D-68167, Germany.,Department of Clinical Pharmacy &Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB, The Netherlands
| | - Robert H Henning
- Department of Clinical Pharmacy &Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB, The Netherlands
| | - Lothar Schilling
- Division of Neurosurgical Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, D-68167, Germany
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Ejaz S, Emmrich JV, Sitnikov SL, Hong YT, Sawiak SJ, Fryer TD, Aigbirhio FI, Williamson DJ, Baron JC. Normobaric hyperoxia markedly reduces brain damage and sensorimotor deficits following brief focal ischaemia. Brain 2016; 139:751-64. [PMID: 26767570 DOI: 10.1093/brain/awv391] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/16/2015] [Indexed: 01/02/2023] Open
Abstract
'True' transient ischaemic attacks are characterized not only clinically, but also radiologically by a lack of corresponding changes on magnetic resonance imaging. During a transient ischaemic attack it is assumed that the affected tissue is penumbral but rescued by early spontaneous reperfusion. There is, however, evidence from rodent studies that even brief focal ischaemia not resulting in tissue infarction can cause extensive selective neuronal loss associated with long-lasting sensorimotor impairment but normal magnetic resonance imaging. Selective neuronal loss might therefore contribute to the increasingly recognized cognitive impairment occurring in patients with transient ischaemic attacks. It is therefore relevant to consider treatments to reduce brain damage occurring with transient ischaemic attacks. As penumbral neurons are threatened by markedly constrained oxygen delivery, improving the latter by increasing arterial O2 content would seem logical. Despite only small increases in arterial O2 content, normobaric oxygen therapy experimentally induces significant increases in penumbral O2 pressure and by such may maintain the penumbra alive until reperfusion. Nevertheless, the effects of normobaric oxygen therapy on infarct volume in rodent models have been conflicting, although duration of occlusion appeared an important factor. Likewise, in the single randomized trial published to date, early-administered normobaric oxygen therapy had no significant effect on clinical outcome despite reduced diffusion-weighted imaging lesion growth during therapy. Here we tested the hypothesis that normobaric oxygen therapy prevents both selective neuronal loss and sensorimotor deficits in a rodent model mimicking true transient ischaemic attack. Normobaric oxygen therapy was applied from the onset and until completion of 15 min distal middle cerebral artery occlusion in spontaneously hypertensive rats, a strain representative of the transient ischaemic attack-prone population. Whereas normoxic controls showed normal magnetic resonance imaging but extensive cortical selective neuronal loss associated with microglial activation (present both at Day 14 in vivo and at Day 28 post-mortem) and marked and long-lasting sensorimotor deficits, normobaric oxygen therapy completely prevented sensorimotor deficit (P < 0.02) and near-completely Day 28 selective neuronal loss (P < 0.005). Microglial activation was substantially reduced at Day 14 and completely prevented at Day 28 (P = 0.002). Our findings document that normobaric oxygen therapy administered during ischaemia nearly completely prevents the neuronal death, microglial inflammation and sensorimotor impairment that characterize this rodent true transient ischaemic attack model. Taken together with the available literature, normobaric oxygen therapy appears a promising therapy for short-lasting ischaemia, and is attractive clinically as it could be started at home in at-risk patients or in the ambulance in subjects suspected of transient ischaemic attack/early stroke. It may also be a straightforward adjunct to reperfusion therapies, and help prevent subtle brain damage potentially contributing to long-term cognitive and sensorimotor impairment in at-risk populations.
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Affiliation(s)
- Sohail Ejaz
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Julius V Emmrich
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Sergey L Sitnikov
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Young T Hong
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Stephen J Sawiak
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Tim D Fryer
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Franklin I Aigbirhio
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - David J Williamson
- 3 Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Jean-Claude Baron
- 1 Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK 4 INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Schneider UC, Karutz T, Schilling L, Woitzik J. Administration of a second generation perfluorochemical in combination with hyperbaric oxygenation does not provide additional benefit in a model of permanent middle cerebral artery occlusion in rats. SPRINGERPLUS 2014; 3:32. [PMID: 25674426 PMCID: PMC4320177 DOI: 10.1186/2193-1801-3-32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/03/2014] [Indexed: 01/24/2023]
Abstract
Objective Both, second generation perfluorochemicals (Oxycyte®) and hyperbaric oxygen (HBO) have been shown to reduce necrotic tissue volume if administered early after experimental cerebral ischemia. With the idea of exponentiation of oxygen delivery to ischemic tissue, this study was conducted to investigate the combined effect of both treatment modalities on the extent of ischemic brain damage. Methods Permanent focal cerebral ischemia was induced in rats by middle cerebral artery occlusion (MCAO). Animals were assigned randomly to one of the following treatment groups: Control (0.9% NaCl, 1 ml/100 g i.v.), Oxycyte® (1 ml/100 g i.v.), HBO (1 bar hyperbaric oxygenation for 1 h) and HBO + Oxycyte® (1 ml/100 g i.v. combined with 1 bar hyperbaric oxygenation for 1 h). Injection of NaCl or Oxycyte® was performed following MCAO. After injection, breathing was changed to 100% oxygen in Oxycyte®-, HBO- and HBO + Oxycyte®-groups. After eight hours the necrotic volume was calculated from serial coronal sections stained with silver-nitrate and corrected for the extent of swelling. Results Hemodynamic and metabolic parameters were not affected by infusion of Oxycyte®. Total necrosis volume was significantly reduced in HBO-treated animals (223 ± 70 mm3), when compared to control animals (335 ± 36 mm3). In animals after Oxycyte®-treatment alone (299 ± 33 mm3) or combined HBO + Oxycyte®-treatment (364 ± 50 mm3) did not show a significantly smaller necrosis volume compared to control animals (necrosis volumes are given as mean ± SD). Discussion These results suggest that combination of hyperbaric oxygenation and Oxycyte® administered immediately after onset of vascular occlusion does not provide an additional neuroprotective effect in the early phase of brain ischemia.
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Affiliation(s)
- Ulf C Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Center for Stroke Research Berlin, Berlin, Germany
| | - Tobias Karutz
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Lothar Schilling
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Center for Stroke Research Berlin, Berlin, Germany ; Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
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Yacoub A, Hajec MC, Stanger R, Wan W, Young H, Mathern BE. Neuroprotective effects of perflurocarbon (oxycyte) after contusive spinal cord injury. J Neurotrauma 2013; 31:256-67. [PMID: 24025081 DOI: 10.1089/neu.2013.3037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Spinal cord injury (SCI) often results in irreversible and permanent neurological deficits and long-term disability. Vasospasm, hemorrhage, and loss of microvessels create an ischemic environment at the site of contusive or compressive SCI and initiate the secondary injury cascades leading to progressive tissue damage and severely decreased functional outcome. Although the initial mechanical destructive events cannot be reversed, secondary injury damage occurs over several hours to weeks, a time frame during which therapeutic intervention could be achieved. One essential component of secondary injury cascade is the reduction in spinal cord blood flow with resultant decrease in oxygen delivery. Our group has recently shown that administration of fluorocarbon (Oxycyte) significantly increased parenchymal tissue oxygen levels during the usual postinjury hypoxic phase, and fluorocarbon has been shown to be effective in stroke and head injury. In the current study, we assessed the beneficial effects of Oxycyte after a moderate-to-severe contusion SCI was simulated in adult Long-Evans hooded rats. Histopathology and immunohistochemical analysis showed that the administration of 5 mL/kg of Oxycyte perfluorocarbon (60% emulsion) after SCI dramatically reduced destruction of spinal cord anatomy and resulted in a marked decrease of lesion area, less cell death, and greater white matter sparing at 7 and 42 days postinjury. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining showed a significant reduced number of apoptotic cells in Oxycyte-treated animals, compared to the saline group. Collectively, these results demonstrate the potential neuroprotective effect of Oxycyte treatment after SCI, and its beneficial effects may be, in part, a result of reducing apoptotic cell death and tissue sparing. Further studies to determine the most efficacious Oxycyte dose and its mechanisms of protection are warranted.
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Affiliation(s)
- Adly Yacoub
- 1 Department of Neurosurgery, Virginia Commonwealth University , Richmond, Virginia
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11
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Torres Filho IP, Pedro JRP, Narayanan SV, Nguyen NM, Roseff SD, Spiess BD. Perfluorocarbon emulsion improves oxygen transport of normal and sickle cell human bloodin vitro. J Biomed Mater Res A 2013; 102:2105-15. [DOI: 10.1002/jbm.a.34885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/10/2013] [Accepted: 07/17/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Ivo P. Torres Filho
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
- Department of Emergency Medicine; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
- US Army Institute of Surgical Research; Damage Control Resuscitation; San Antonio Texas 78234
| | - José Ricardo P. Pedro
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Srinivasan V. Narayanan
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Nguyen M. Nguyen
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Susan D. Roseff
- Department of Pathology; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Bruce D. Spiess
- Department of Emergency Medicine; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
- Department of Anesthesiology; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
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In vivo microvascular mosaics show air embolism reduction after perfluorocarbon emulsion treatment. Microvasc Res 2012; 84:390-4. [DOI: 10.1016/j.mvr.2012.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/14/2012] [Accepted: 08/13/2012] [Indexed: 11/24/2022]
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13
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Seiffge DJ, Lapina NE, Tsagogiorgas C, Theisinger B, Henning RH, Schilling L. Improvement of oxygen supply by an artificial carrier in combination with normobaric oxygenation decreases the volume of tissue hypoxia and tissue damage from transient focal cerebral ischemia. Exp Neurol 2012; 237:18-25. [PMID: 22728375 DOI: 10.1016/j.expneurol.2012.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/04/2012] [Accepted: 06/09/2012] [Indexed: 11/29/2022]
Abstract
Tissue hypoxia may play an important role in the development of ischemic brain damage. In the present study we investigated in a rat model of transient focal brain ischemia the neuroprotective effects of increasing the blood oxygen transport capacity by applying a semifluorinated alkane (SFA)-containing emulsion together with normobaric hyperoxygenation (NBO). The spread of tissue hypoxia was studied using pimonidazole given prior to filament-induced middle cerebral artery occlusion (MCAO, 2 h). Treatment consisted of intravenous injection of saline or the SFA-containing emulsion (0.5 or 1.0 ml/100g body weight; [SFA(0.5) or SFA(1.0)]) either upon establishing MCAO (early treatment) or after filament removal (delayed treatment). After injection NBO was administered for 8 h (early treatment) or 6 h (delayed treatment). Experiments were terminated 8 or 24 h after MCAO. In serial brain sections tissue hypoxia and irreversible cell damage were quantitatively determined. Furthermore, we studied hypoxia-related gene expression (VEGF, flt-1). Early treatment significantly (p<0.05) reduced the volumes of tissue damage (8 h after MCAO: SFA(1.0), 57±34 mm³; controls, 217±70 mm³; 24 h after MCAO: SFA(1.0), 189±82 mm³; controls, 317±60 mm³) and of P-Add immunoreactivity (8 h after MCAO: SFA(1.0), 261±37 mm³; controls, 339±26 mm³; 24h after MCAO: SFA(1.0), 274±47 mm³; controls, 364±46 mm³). Delayed treatment was comparably successful. The volume of the hypoxic penumbra was not decreased by the treatment. Similarly, VEGF and flt-1 mRNA levels did not differ between the experimental groups. From these data we conclude that increasing the blood oxygen transport capacity in the plasma compartment provides a neuroprotective effect by alleviating the severity of hypoxia to a level sufficient to prevent cells from transition into irreversible damage.
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Affiliation(s)
- David J Seiffge
- Division of Neurosurgical Research, Medical Faculty Mannheim, University of Heidelberg, Germany
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Delaying blood transfusion in experimental acute anemia with a perfluorocarbon emulsion. Anesthesiology 2011; 114:901-11. [PMID: 21326091 DOI: 10.1097/aln.0b013e31820efb36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND To avoid unnecessary blood transfusions, physiologic transfusion triggers, rather than exclusively hemoglobin-based transfusion triggers, have been suggested. The objective of this study was to determine systemic and microvascular effects of using a perfluorocarbon-based oxygen carrier (PFCOC) to maintain perfusion and oxygenation during extreme anemia. METHODS The hamster (weight, 55-65 g) window chamber model was used. Two isovolemic hemodilution steps were performed using hydroxyethyl starch, 10%, at normoxic conditions to a hematocrit of 19% (hemoglobin, 5.5 g/dl), the point at which the transfusion trigger was reached. Two additional hemodilution exchanges using the PFCOC (Oxycyte) and increasing the fraction of inspired oxygen to 1.0 were performed to reduce the hematocrit to 11% (hemoglobin, 3.8 g/dl) and 6% (hemoglobin, 2.0 g/dl), respectively. No control group was used in the study because this concentration of hemodilution is lethal with conventional plasma expanders. Systemic parameters, microvascular perfusion, functional capillary density, and oxygen tensions across the microvascular network were measured. RESULTS At 6% hematocrit, the PFCOC maintained mean arterial pressure, cardiac output, systemic oxygen delivery, and oxygen consumption. As hematocrit was decreased from 11% to 6%, functional capillary density, calculated microvascular oxygen delivery, and oxygen consumption decreased; and the oxygen extraction ratio was close to 100%. Peripheral tissue oxygenation was not predicted by systemic oxygenation. CONCLUSIONS The PFCOC, in conjunction with hyperoxia, was able to sustain organ function and partially provide systemic oxygenation during extreme anemia during the observation period. The PFCOC can work as a bridge until erythrocytes are available for transfusion or when additional oxygen is required, despite the possible limitations in peripheral tissue oxygenation.
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Short Period of Early Reperfusion Aggravates Blood–Brain Barrier Dysfunction During Permanent Focal Ischemia in Rats. Transl Stroke Res 2010; 2:67-71. [DOI: 10.1007/s12975-010-0042-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 08/22/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
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Spiess BD. Perfluorocarbon emulsions as a promising technology: a review of tissue and vascular gas dynamics. J Appl Physiol (1985) 2009; 106:1444-52. [PMID: 19179651 DOI: 10.1152/japplphysiol.90995.2008] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Perfluorocarbon (PFC) emulsions are halogen-substituted carbon nonpolar oils with resultant enhanced dissolved respiratory gas (O(2), N(2), CO(2), nitric oxide) capabilities. In the first demonstration of enhanced O(2) solubility, inhaled PFC could sustain rat metabolism. Intravenous emulsions were then trialed as "blood substitutes." In the last 10 yr, biocomputational modeling has enhanced our mechanistic understanding of PFCs. Contemporary research is now taking advantage of these physiological discoveries and applying PFCs as "oxygen therapeutics," as well as ways to enhance other gas movements. One particularly promising area of research is the treatment of gas embolism (arterial and venous emboli/decompression sickness). An expansive understanding of PFC-enhanced diffusive gas movements through tissue and vasculature may have analogous applications for O(2) or other respiratory gases and should provide a revolution in medicine. This review will stress the fundamental knowledge we now have regarding how respiratory gas movements are changed when intravenous PFC is present.
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Affiliation(s)
- Bruce D Spiess
- Department of Anesthesiology and Emergency Medicine, Virginia Commonwealth University Reanimation Engineering Shock Center, Richmond, Virginia, USA.
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Yang ZJ, Price CD, Bosco G, Tucci M, El-Badri NS, Mangar D, Camporesi EM. The effect of isovolemic hemodilution with oxycyte, a perfluorocarbon emulsion, on cerebral blood flow in rats. PLoS One 2008; 3:e2010. [PMID: 18431491 PMCID: PMC2291566 DOI: 10.1371/journal.pone.0002010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/04/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cerebral blood flow (CBF) is auto-regulated to meet the brain's metabolic requirements. Oxycyte is a perfluorocarbon emulsion that acts as a highly effective oxygen carrier compared to blood. The aim of this study is to determine the effects of Oxycyte on regional CBF (rCBF), by evaluating the effects of stepwise isovolemic hemodilution with Oxycyte on CBF. METHODOLOGY Male rats were intubated and ventilated with 100% O(2) under isoflurane anesthesia. The regional (striatum) CBF (rCBF) was measured with a laser doppler flowmeter (LDF). Stepwise isovolemic hemodilution was performed by withdrawing 4ml of blood and substituting the same volume of 5% albumin or 2 ml Oxycyte plus 2 ml albumin at 20-minute intervals until the hematocrit (Hct) values reached 5%. PRINCIPAL FINDINGS In the albumin-treated group, rCBF progressively increased to approximately twice its baseline level (208+/-30%) when Hct levels were less than 10%. In the Oxycyte-treated group on the other hand, rCBF increased by significantly smaller increments, and this group's mean rCBF was only slightly higher than baseline (118+/-18%) when Hct levels were less than 10%. Similarly, in the albumin-treated group, rCBF started to increase when hemodilution with albumin caused the CaO(2) to decrease below 17.5 ml/dl. Thereafter, the increase in rCBF was accompanied by a nearly proportional decrease in the CaO(2) level. In the Oxycyte-treated group, the increase in rCBF was significantly smaller than in the albumin-treated group when the CaO(2) level dropped below 10 ml/dl (142+/-20% vs. 186+/-26%), and rCBF returned to almost baseline levels (106+/-15) when the CaO(2) level was below 7 ml/dl. CONCLUSIONS/SIGNIFICANCE Hemodilution with Oxycyte was accompanied with higher CaO(2) and PO(2) than control group treated with albumin alone. This effect may be partially responsible for maintaining relatively constant CBF and not allowing the elevated blood flow that was observed with albumin.
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Affiliation(s)
- Zhong-jin Yang
- Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Chrystal D. Price
- Department of Anesthesiology, University of South Florida, Tampa, Florida
| | - Gerardo Bosco
- Department of Physiology, University of Chieti, Chieti, Italy
| | - Micheal Tucci
- Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - Nagwa S. El-Badri
- Department of Anesthesiology, University of South Florida, Tampa, Florida
| | - Devanand Mangar
- Department of Anesthesiology, University of South Florida, Tampa, Florida
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de Lange F, Yoshitani K, Proia AD, Mackensen GB, Grocott HP. Perfluorocarbon Administration During Cardiopulmonary Bypass in Rats: An Inflammatory Link to Adverse Outcome? Anesth Analg 2008; 106:24-31, table of contents. [DOI: 10.1213/01.ane.0000297439.90773.c7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
OBJECT Selective intraarterial drug delivery is used to achieve enhanced local uptake with reduced systemic side effects. In the present paper the authors describe and characterize a new microcatheter-based model of superselective perfusion of the middle cerebral artery (MCA) in rats combined with blockade of blood flow through the MCA. METHODS Selectivity of administration was shown by infusion of Evans blue which diffusely stained the MCA territory, indicating an increased permeability of the blood-brain barrier during the blockade of blood flow to the MCA. Perfusion of autologous blood through the microcatheter resulted in a flow rate-related increase in the cerebral blood flow measured by laser Doppler flowmetry. Similarly, infusion of an artificial O2 carrier, Oxycyte, was accompanied by an increase in tissue oxygenation as measured using a Licox sensor. Blockade of blood flow to the MCA with the new microcatheter for an extended period of time resulted in the development of ischemia, which was comparable to that induced by intravascular occlusion using a silicone-coated thread. In a 24-hour MCA occlusion model, selective administration of a low dose of MK-801 (0.3 mg/kg body weight) resulted in a significantly smaller infarct volume than systemic application (339 +/- 53 mm(3) compared with 508 +/- 26 mm(3), p < 0.001). CONCLUSIONS This new model of superselective MCA infusion is a valuable tool for investigating the effect of selective delivery and enhanced drug uptake into cerebral ischemic tissue. Without constant blockade of blood flow through the MCA it may also be useful for enhanced drug uptake, gene transfer, or application of stem cells in other neuropathological conditions.
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Affiliation(s)
- Johannes Woitzik
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, Ruprecht-Karls- University Heidelberg, Mannheim, Germany.
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Cabrales P, Tsai AG, Intaglietta M. Perfluorocarbon in microcirculation during ischemia reperfusion. J Am Coll Surg 2007; 204:225-35. [PMID: 17254926 DOI: 10.1016/j.jamcollsurg.2006.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 08/23/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effects of perfluorocarbon (PFC) emulsions administered at a nonhemodiluting dose were studied in the hamster window chamber model to determine the difference in ischemia-reperfusion injury associated with PFC delivery before and after an ischemic episode. STUDY DESIGN Ischemia was induced by compressing the periphery of the window chamber for 1 hour. Vessel diameter, red blood cell velocity, rolling and adherent leukocytes, and functional capillary density (FCD) were assessed by intravital microscopy. The animals received an infusion (10% blood volume) of PFC emulsion or equivalent volumes of saline, before or after ischemia. Two groups were studied in each experimental protocol: A, infusion after ischemia; and B, infusion before ischemia, where a fraction of the infused material stagnated in the ischemic zone during the occlusion time. Measurements were made before induced ischemia and at 0.5, 2, and 24 hours of reperfusion. RESULTS Animals treated with PFC after ischemia had substantially decreased leukocytes rolling and sticking in postcapillary venules and recovered functional capillary density and blood flow when compared with saline-treated controls. Conversely, administration of PFC before ischemia considerably reduced functional capillary density and increased leukocyte activation after reperfusion. CONCLUSIONS Results indicate that PFC without stagnation within an ischemic zone attenuates postischemic reperfusion injury of striated skin muscle, presumably through the reduction of leukocyte-endothelial cell interactions. Accordingly, PFC effects on ischemia-reperfusion injury are determined mainly by the time of administration relative to the ischemic episodes.
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Affiliation(s)
- Pedro Cabrales
- La Jolla Bioengineering Institute, La Jolla, CA.; Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
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