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Chen J, Chen Y, Lin Y, Long J, Chen Y, He J, Huang G. Roles of Bilirubin in Hemorrhagic Transformation of Different Types and Severity. J Clin Med 2023; 12:jcm12041471. [PMID: 36836007 PMCID: PMC9966404 DOI: 10.3390/jcm12041471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke (AIS). This study was performed to explore and validate the relation between bilirubin levels and spontaneous HT (sHT) and HT after mechanical thrombectomy (tHT). METHODS The study population consisted of 408 consecutive AIS patients with HT and age- and sex-matched patients without HT. All patients were divided into quartiles according to total bilirubin (TBIL) level. HT was classified as hemorrhagic infarction (HI) and parenchymal hematoma (PH) based on radiographic data. RESULTS In this study, the baseline TBIL levels were significantly higher in the HT than non-HT patients in both cohorts (p < 0.001). Furthermore, the severity of HT increased with increasing TBIL levels (p < 0.001) in sHT and tHT cohorts. The highest quartile of TBIL was associated with HT in sHT and tHT cohorts (sHT cohort: OR = 3.924 (2.051-7.505), p < 0.001; tHT cohort: OR = 3.557 (1.662-7.611), p = 0.006). CONCLUSIONS Our results suggest that an increased TBIL is associated with a high risk of patients with sHT and tHT, and that TBIL is more suitable as a predictor for sHT than tHT. These findings may help to identify patients susceptible to different types and severity of HT.
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Affiliation(s)
- Jiahao Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yiting Chen
- School of Foreign Language Studies, Wenzhou Medical University, Wenzhou 325000, China
| | - Yisi Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jingfang Long
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yufeng Chen
- Department of General Practice, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: (J.H.); (G.H.)
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Correspondence: (J.H.); (G.H.)
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Benatti HR, Gray-Edwards HL. Adeno-Associated Virus Delivery Limitations for Neurological Indications. Hum Gene Ther 2022; 33:1-7. [PMID: 35049369 DOI: 10.1089/hum.2022.29196.hrb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hector Ribeiro Benatti
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Heather L Gray-Edwards
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Bittermann S, Schild C, Marti E, Mirkovitch J, Schweizer D, Henke D. Analysis of blood degradation products and ferritin in the cerebrospinal fluid of dogs with acute thoracolumbar intervertebral disk extrusion, a prospective pilot study. BMC Vet Res 2019; 15:148. [PMID: 31088486 PMCID: PMC6518634 DOI: 10.1186/s12917-019-1878-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background Hemorrhage in the spinal canal leads to further damage of the spinal cord influencing outcome in dogs with intervertebral disk (IVD) extrusion. The aim of the study was to evaluate blood degradation products and ferritin in the cerebrospinal fluid (CSF) of dogs with thoracolumbar IVD extrusion, and their association to clinical parameters and MRI findings. Results In the CSF of dogs with IVD extrusion, both net oxyhemoglobin absorption (NOA) and net bilirubin absorption (NBA) were significantly higher compared to the control groups of dogs with steroid responsive meningitis arteritis (SRMA) and idiopathic epilepsy (IE) (P < 0.001), but NOA compared to the idiopathic epilepsy group contaminated artificially with blood (IEc) was not (P = 0.890). Ferritin concentration was significantly higher in dogs with IVD extrusion compared to dogs with IE (P = 0.034), but not to dogs with SRMA (P = 0.526). There was no association between NOA, NBA or ferritin concentration and severity or duration of clinical signs. In dogs with a higher ferritin concentration the outcome was better (P = 0.018). In dogs with evidence of hemorrhage on MRI, NOA and NBA were significantly higher (P = 0.016, P = 0.009), but not ferritin (P = 0.0628). Conclusion and clinical importance Quantification of blood degradation products and ferritin in the CSF of dogs to assess subarachnoidal hemorrhage is feasible; however, larger case numbers are needed to evaluate the relevance of NBA and ferritin as prognostic indicators.
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Affiliation(s)
- Sophie Bittermann
- Division of Neurological Sciences, Division of Clinical Veterinary Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland.
| | - Christof Schild
- Institute of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, INO-F3010, Bern, Switzerland
| | - Eliane Marti
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
| | - Jelena Mirkovitch
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
| | - Daniela Schweizer
- Division of Neurological Sciences, Division of Veterinary Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
| | - Diana Henke
- Division of Neurological Sciences, Division of Clinical Veterinary Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Laenggassstrasse 128, 3012, Bern, Switzerland
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Backer-Grøndahl A, Lindal S, Lorentzen MA, Eldevik P, Vorren T, Kristiansen B, Vangberg T, Ytrebø LM. A new non-craniotomy model of subarachnoid hemorrhage in the pig: a pilot study. Lab Anim 2015; 50:379-89. [PMID: 26643281 DOI: 10.1177/0023677215619806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subarachnoid hemorrhage (SAH) from rupture of an intracranial arterial aneurysm is a devastating disease affecting young people, with serious lifelong disability or death as a frequent outcome. Large animal models that exhibit all the cardinal clinical features of human SAH are highly warranted. In this pilot study we aimed to develop a non-craniotomy model of SAH in pigs suitable for acute intervention studies. Six Norwegian Landrace pigs received advanced invasive hemodynamic and intracranial pressure (ICP) monitoring. The subarachnoid space, confirmed by a clear cerebrospinal fluid (CSF) tap, was reached by advancing a needle below the ocular bulb through the superior orbital fissure and into the interpeduncular cistern. SAH was induced by injecting 15 mL of autologous arterial blood into the subarachnoid space. Macro- and microanatomical investigations of the pig brain showed a typical blood distribution consistent with human aneurysmal SAH (aSAH) autopsy data. Immediately after SAH induction ICP sharply increased with a concomitant reduction in cerebral perfusion pressure (CPP). ICP returned to near normal values after 30 min, but increased subsequently during the experimental period. Signs of brain edema were confirmed by light microscopy post-mortem. None of the animals died during the experimental period. This new transorbital injection model of SAH in the pig mimics human aSAH and may be suitable for acute intervention studies. However, the model is technically challenging and needs further validation.
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Affiliation(s)
- Anders Backer-Grøndahl
- Department of Anesthesiology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Sigurd Lindal
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway Department of Pathology, University Hospital of North Norway, Tromsø, Norway
| | | | - Petter Eldevik
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Torgrim Vorren
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Bente Kristiansen
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Torgil Vangberg
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Lars Marius Ytrebø
- Department of Anesthesiology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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Nyberg C, Karlsson T, Hillered L, Engström ER. Metabolic pattern of the acute phase of subarachnoid hemorrhage in a novel porcine model: studies with cerebral microdialysis with high temporal resolution. PLoS One 2014; 9:e99904. [PMID: 24940881 PMCID: PMC4062436 DOI: 10.1371/journal.pone.0099904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/19/2014] [Indexed: 12/30/2022] Open
Abstract
Background Aneurysmal subarachnoid hemorrhage (SAH) may produce cerebral ischemia and systemic responses including stress. To study immediate cerebral and systemic changes in response to aneurysm rupture, animal models are needed. Objective To study early cerebral energy changes in an animal model. Methods Experimental SAH was induced in 11 pigs by autologous blood injection to the anterior skull base, with simultaneous control of intracranial and cerebral perfusion pressures. Intracerebral microdialysis was used to monitor concentrations of glucose, pyruvate and lactate. Results In nine of the pigs, a pattern of transient ischemia was produced, with a dramatic reduction of cerebral perfusion pressure soon after blood injection, associated with a quick glucose and pyruvate decrease. This was followed by a lactate increase and a delayed pyruvate increase, producing a marked but short elevation of the lactate/pyruvate ratio. Glucose, pyruvate, lactate and lactate/pyruvate ratio thereafter returned toward baseline. The two remaining pigs had a more severe metabolic reaction with glucose and pyruvate rapidly decreasing to undetectable levels while lactate increased and remained elevated, suggesting persisting ischemia. Conclusion The animal model simulates the conditions of SAH not only by deposition of blood in the basal cisterns, but also creating the transient global ischemic impact of aneurysmal SAH. The metabolic cerebral changes suggest immediate transient substrate failure followed by hypermetabolism of glucose upon reperfusion. The model has features that resemble spontaneous bleeding, and is suitable for future research of the early cerebral and systemic responses to SAH that are difficult to study in humans.
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Affiliation(s)
- Christoffer Nyberg
- Department of Neuroscience, section of Neurosurgery, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Torbjörn Karlsson
- Department of Surgical Sciences, section of Anesthesiology and Intensive care, Uppsala University, Uppsala, Sweden
| | - Lars Hillered
- Department of Neuroscience, section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Marshman LA, Duell R, Rudd D, Johnston R, Faris C. Intraobserver and Interobserver Agreement in Visual Inspection for Xanthochromia. Neurosurgery 2014; 74:395-9; discussion 399-400. [DOI: 10.1227/neu.0000000000000291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Jakola AS, Jørgensen A, Selbekk T, Michler RP, Solheim O, Torp SH, Sagberg LM, Aadahl P, Unsgård G. Animal study assessing safety of an acoustic coupling fluid that holds the potential to avoid surgically induced artifacts in 3D ultrasound guided operations. BMC Med Imaging 2014; 14:11. [PMID: 24666721 PMCID: PMC3977940 DOI: 10.1186/1471-2342-14-11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/19/2014] [Indexed: 11/18/2022] Open
Abstract
Background Use of ultrasound in brain tumor surgery is common. The difference in attenuation between brain and isotonic saline may cause artifacts that degrade the ultrasound images, potentially affecting resection grades and safety. Our research group has developed an acoustic coupling fluid that attenuates ultrasound energy like the normal brain. We aimed to test in animals if the newly developed acoustic coupling fluid may have harmful effects. Methods Eight rats were included for intraparenchymal injection into the brain, and if no adverse reactions were detected, 6 pigs were to be included with injection of the coupling fluid into the subarachnoid space. Animal behavior, EEG registrations, histopathology and immunohistochemistry were used in assessment. Results In total, 14 animals were included, 8 rats and 6 pigs. We did not detect any clinical adverse effects, seizure activity on EEG or histopathological signs of tissue damage. Conclusion The novel acoustic coupling fluid intended for brain tumor surgery appears safe in rats and pigs under the tested circumstances.
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Affiliation(s)
- Asgeir S Jakola
- Department of Neurosurgery, St,Olavs University Hospital, Trondheim, N-7006, Norway.
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Titova E, Ostrowski RP, Zhang JH, Tang J. Experimental models of subarachnoid hemorrhage for studies of cerebral vasospasm. Neurol Res 2013; 31:568-81. [DOI: 10.1179/174313209x382412] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Qiao A, Zeng K. Numerical simulation of hemodynamics in intracranial saccular aneurysm treated with a novel stent. Neurol Res 2013; 35:701-8. [PMID: 23561548 DOI: 10.1179/1743132813y.0000000186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Different from the traditional stents, a novel stent with triangular wire cross-section is proposed, and numerical simulation is performed to compare the hemodynamic effect of the novel stent with that of traditional ones. Three kinds of stents with circular, rectangular, and triangular wire cross-sections were designed to treat saccular aneurysm, which were named the C-stent model, the R-stent model, and the T-stent model, respectively. An unstented aneurysm model (named the Unstented model), as a control, was also designed. Fluid-structure interaction in these four models was simulated. The results demonstrate that the resistance of the novel T-stent model is lower than that of the R-stent model, but higher than that of the C-stent model. Compared with the C-stent model, the T-stent model exhibits greater velocity decrease and longer turnover time. Meanwhile, the pressure increase of the T-stent model is lower than the R-stent model, and the magnitude and the fluctuation of wall shear stress is optimized in the T-stent model. The novel stent with a bare triangular wire cross-section has some comparative advantages. These results may provide some theoretical guidance for the structural design of an endovascular stent for the interventional treatment of aneurysm.
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Affiliation(s)
- Aike Qiao
- Beijing University of Technology, Beijing, China
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10
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Global CNS gene delivery and evasion of anti-AAV-neutralizing antibodies by intrathecal AAV administration in non-human primates. Gene Ther 2013; 20:450-9. [PMID: 23303281 PMCID: PMC3618620 DOI: 10.1038/gt.2012.101] [Citation(s) in RCA: 262] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Injection of AAV into the cerebrospinal fluid (CSF) offers a means to achieve widespread transgene delivery to the central nervous system, where the doses can be readily translated from small to large animals. In contrast to studies with other serotypes (AAV2, AAV4, AAV5) in rodents, we report that a naturally-occurring capsid (AAV9) and rationally-engineered capsid (AAV2.5) are able to achieve broad transduction throughout the brain and spinal cord parenchyma following a single injection into the CSF (via cisterna magna or lumbar cistern) in non-human primates (NHP). Using either vector at a dose of ~2×1012 vg per 3-6 kg animal, approximately 2% of the entire brain and spinal cord was transduced, covering all regions of the CNS. AAV9 in particular displayed efficient transduction of spinal cord motor neurons. The peripheral organ biodistribution was highly reduced compared to intravascular delivery, and the presence of circulating anti-AAV neutralizing antibodies up to a 1:128 titer had no inhibitory effect on CNS gene transfer. Intra-CSF delivery effectively translates from rodents to NHPs, which provides encouragement for the use of this approach in humans to treat motor neuron and lysosomal storage diseases.
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Nagy K, Skagervik I, Tumani H, Petzold A, Wick M, Kühn HJ, Uhr M, Regeniter A, Brettschneider J, Otto M, Kraus J, Deisenhammer F, Lautner R, Blennow K, Shaw L, Zetterberg H, Mattsson N. Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage? Clin Chem Lab Med 2013; 51:2073-86. [DOI: 10.1515/cclm-2012-0783] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 03/12/2013] [Indexed: 11/15/2022]
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Pyne-Geithman GJ, Nair SG, Stamper DNC, Clark JF. Role of bilirubin oxidation products in the pathophysiology of DIND following SAH. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 115:267-73. [PMID: 22890679 DOI: 10.1007/978-3-7091-1192-5_47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite intensive research efforts, by our own team and many others, the molecules responsible for acute neurological damage following subarachnoid hemorrhage (SAH) and contributing to delayed ischemic neurological deficit (DIND) have not yet been elucidated. While there are a number of candidate mechanisms, including nitric oxide (NO) scavenging, endothelin-1, protein kinase C (PKC) activation, and rho kinase activation, to name but a few, that have been investigated using animal models and human trials, we are, it seems, no closer to discovering the true nature of this complex and enigmatic pathology. Efforts in our laboratory have focused on the chemical milieu present in hemorrhagic cerebrospinal fluid (CSF) following SAH and the interaction of the environment with the molecules generated by SAH and subsequent events, including NO scavenging, immune response, and clot breakdown. We have identified and characterized a group of molecules formed by the oxidative degradation of bilirubin (a clot breakdown product) and known as BOXes (bilirubin oxidation products). We present a synopsis of the characterization of BOXes as found in human SAH patients' CSF and the multiple signaling pathways by which BOXes act. In summary, BOXes are likely to play an essential role in the etiology of acute brain injury following SAH, as well as DIND.
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Cruickshank A, Auld P, Beetham R, Burrows G, Egner W, Holbrook I, Keir G, Lewis E, Patel D, Watson I, White P. Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Ann Clin Biochem 2008; 45:238-44. [DOI: 10.1258/acb.2008.007257] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is crucially important to detect subarachnoid haemorrhage (SAH) in all patients in whom it has occurred to select patients for angiography and preventative surgery. A computerized tomography (CT) scan is positive in up to 98% of patients with SAH presenting within 12 h, but is positive in only 50% of those presenting within one week. Cerebrospinal fluid (CSF) bilirubin spectrophotometry can be used to determine the need for angiography in those few CT-negative patients in whom clinical suspicion of SAH remains high; it may remain positive up to two weeks after the event. A lumbar puncture (LP) should only be performed >12 h after the onset of presenting symptoms. Whenever possible collect sequential specimens. Always ensure that the least blood-stained CSF sample taken (usually the last) is sent for bilirubin analysis. Protect the CSF from light and avoid vacuum tube transport systems, if possible. Always use spectrophotometry in preference to visual inspection. All CSF specimens are precious and should always be analysed unless insufficient sample is received. Centrifuge the specimen at >2000 rpm for 5 min as soon as possible after receipt in the laboratory. Store the supernatant at 4°C in the dark until analysis. An increase in CSF bilirubin is the key finding, which supports the occurrence of SAH but is not specific for this. In most positive cases, bilirubin will occur with oxyhaemoglobin.
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Affiliation(s)
- Anne Cruickshank
- Department of Biochemistry, Southern General Hospital, Glasgow G51 4TF
| | - Peter Auld
- Department of Clinical Biochemistry, Belfast Trust Hospital, Belfast BT12 6BA
| | - Robert Beetham
- Department of Clinical Biochemistry, Frenchay Hospital, Bristol BS16 1LE
| | - Gillian Burrows
- Department of Biochemistry, Stepping Hill Hospital, Stockport SK2 7JE
| | - William Egner
- Department of Immunology, Northern General Hospital, Sheffield S5 7YT
| | - Ian Holbrook
- Department of Clinical Biochemistry, York Hospital, York YO31 8HE
| | - Geoff Keir
- Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, London, WC1 N 3BG
| | - Emma Lewis
- Department of Clinical Biochemistry, University Hospital, Aintree, Liverpool L9 7AL, UK
| | - Dina Patel
- Department of Immunology, Northern General Hospital, Sheffield S5 7YT
| | - Ian Watson
- Department of Clinical Biochemistry, University Hospital, Aintree, Liverpool L9 7AL, UK
| | - Peter White
- Department of Immunology, Northern General Hospital, Sheffield S5 7YT
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Bilirubin oxidation products (BOXes): synthesis, stability and chemical characteristics. ACTA NEUROCHIRURGICA SUPPLEMENT 2008; 104:43-50. [DOI: 10.1007/978-3-211-75718-5_8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Clark JF, Sharp FR. Bilirubin oxidation products (BOXes) and their role in cerebral vasospasm after subarachnoid hemorrhage. J Cereb Blood Flow Metab 2006; 26:1223-33. [PMID: 16467784 DOI: 10.1038/sj.jcbfm.9600280] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Many factors have been postulated to cause delayed subarachnoid hemorrhage (SAH)-induced vasospasm, including hemoglobin, nitric oxide, endothelin, and free radicals. We propose that free radicals (because of the high levels that are produced in the blood clots surrounding blood vessels after SAH) act on bilirubin, biliverdin, and possibly heme to produce BOXes (Bilirubin OXidized Products). Bilirubin oxidation products act on vascular smooth muscle cells to produce chronic vasoconstriction and vasospasm combined with a vasculopathy because of smooth muscle cell injury. This review summarizes recent evidence that BOXes play a role in SAH-induced vasospasm. The data supporting a role for BOXes includes (1) identification of molecules in cerebrospinal fluid (CSF) of patients with vasospasm after SAH that have structures consistent with BOXes; (2) BOXes are vasoactive in vitro and mimic the biochemical actions of CSF of patients with vasospasm; (3) BOXes are vasoactive in vivo, constricting rat cerebral vessels; and (4) there is a correlation between clinical occurrence of vasospasm and BOXes concentration in our preliminary study of patients with SAH. Since oxidation of bilirubin, biliverdin, and perhaps heme is proposed to produce BOXes that contribute to vasospasm, either blocking bilirubin formation, inactivating bilirubin or BOXes, or removing all of the blood clot before vasospasm are potential treatment targets.
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Affiliation(s)
- Joseph F Clark
- Department of Neurology, Vontz Center for Molecular Studies, University of Cincinnati, Cincinnati, Ohio 45267-0536, USA.
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16
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Pyne-Geithman GJ, Morgan CJ, Wagner K, Dulaney EM, Carrozzella J, Kanter DS, Zuccarello M, Clark JF. Bilirubin production and oxidation in CSF of patients with cerebral vasospasm after subarachnoid hemorrhage. J Cereb Blood Flow Metab 2005; 25:1070-7. [PMID: 15789034 DOI: 10.1038/sj.jcbfm.9600101] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Delayed cerebral vasospasm after subarachnoid hemorrhage (SAH) remains a significant cause of mortality and morbidity; however, the etiology is, as yet, unknown, despite intensive research efforts. Research in this laboratory indicates that bilirubin and oxidative stress may be responsible by leading to formation of bilirubin oxidation products (BOXes), so we investigated changes in bilirubin concentration and oxidative stress in vitro, and in cerebral spinal fluid (CSF) from SAH patients. Non-SAH CSF, a source of heme oxygenase I (HO-1), and blood were incubated, and in vitro bilirubin production measured. Cerebrospinal fluid from SAH patients was collected, categorized using stimulation of vascular smooth muscle metabolism in vitro, and information obtained regarding occurrence of vasospasm in the patients. Cerebral spinal fluid was analyzed for hemoglobin, total protein and bilirubin, BOXes, malonyldialdehyde and peroxidized lipids (indicators of an oxidizing environment), and HO-1 concentration. The formation of bilirubin in vitro requires that CSF is present, as well as whole, non-anti-coagulated blood. Bilirubin, BOXes, HO-1, and peroxidized lipid content were significantly higher in CSF from SAH patients with vasospasm, compared with nonvasospasm SAH CSF, and correlated with occurrence of vasospasm. We conclude that vasospasm may be more likely in patients with elevated BOXes. The conditions necessary for the formation of BOXes are indeed present in CSF from SAH patients with vasospasm, but not CSF from SAH patients without vasospasm.
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Affiliation(s)
- Gail J Pyne-Geithman
- Department of Neurology, University of Cincinnati, Vontz Center for Molecular Studies, Cincinnati, Ohio 45267-0536, USA.
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Clark JF, Pyne-Geithman G. Vascular smooth muscle function: The physiology and pathology of vasoconstriction. PATHOPHYSIOLOGY 2005; 12:35-45. [PMID: 15927823 DOI: 10.1016/j.pathophys.2005.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 02/22/2005] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Joseph F Clark
- Department of Neurology (ML 0536), University of Cincinnati, Cincinnati, OH 45267-0536, USA
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