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Zhang J, Li H, Xu Z, Lu J, Cao C, Shen H, Li X, You W, Chen G. Oestrogen ameliorates blood-brain barrier damage after experimental subarachnoid haemorrhage via the SHH pathway in male rats. Stroke Vasc Neurol 2023; 8:217-228. [PMID: 36526331 PMCID: PMC10359806 DOI: 10.1136/svn-2022-001907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Sex differences affect the occurrence, progression and regression of subarachnoid haemorrhage (SAH). Oestrogen plays a protective role in alleviating the vasospasm and neuronal apoptosis induced by SAH. However, whether oestrogen affects blood‒brain barrier (BBB) integrity has not been fully studied. Oestrogen has been found to regulate the sonic hedgehog (SHH) signalling pathway through the oestrogen receptor in gastric cancer and adrenal glands, and the SHH signalling pathway has an important role in maintaining the BBB by upregulating the expression of tight junction proteins. In this study, we investigated the relationship between oestrogen and the SHH signalling pathway using clinical data and established an experimental SAH model to explore whether oestrogen could ameliorate BBB damage after SAH through the SHH pathway. METHODS Correlations between oestrogen and the SHH pathway were analysed by patients' cerebrospinal fluid (CSF) samples and the Genotype-Tissue Expression database (GTEx). Then, an experimental rat SAH model was established using the endovascular perforation method and treated with oestrogen, oestrogen inhibitors and SHH signalling pathway inhibitors. Then, the effects of oestrogen on BBB damage were analysed by western blot, immunofluorescence and neurobehavioural experiments. RESULTS ESLIA detection and correlation analysis showed that oestrogen levels in patients' CSF were positively correlated with the SHH pathway, which was further verified by GTEx gene-correlation analysis. SHH was found to be mainly expressed in neurons and astrocytes in rats under physiological conditions and was upregulated by oestrogen pretreatment. In the SAH model, oestrogen pretreatment was found to reverse SAH-induced decreases in the SHH pathway, which were counteracted by oestrogen receptor inhibitors. Furthermore, oestrogen pretreatment reduced SAH-induced BBB damage, brain oedema and neurological dysfunction, which were eliminated by SHH pathway inhibitors. CONCLUSION In conclusion, we demonstrate here that oestrogen pretreatment ameliorates brain injury after SAH, at least in part through SHH pathway-mediated BBB protection.
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Affiliation(s)
- Jie Zhang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Haiying Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Zhongmou Xu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Jinxin Lu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Chang Cao
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Haitao Shen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Xiang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Wanchun You
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Stroke Research, Soochow University, Suzhou, China
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Scullen T, Mathkour M, Dumont AS. Commentary: Formation, Growth, or Rupture of De Novo Intracranial Aneurysms: Long-Term Follow-up Study of Subarachnoid Hemorrhage Survivors. Neurosurgery 2022; 90:e67-e69. [PMID: 34995253 DOI: 10.1227/neu.0000000000001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Pathogenic Factors and Prognosis of De Novo Aneurysms vAfter Aneurysm Clipping. J Craniofac Surg 2021; 33:1800-1805. [PMID: 34974461 DOI: 10.1097/scs.0000000000008451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To confirm this hypothesis, this study aimed to explore the pathogenic factors, prognosis, and their relationship in de novo aneurysms and to reach a consensus on their management. METHODS First, the clinical data of 5 patients with de novo aneurysms from April 1998 to October 2021 were analyzed retrospectively. Then, the English literature on de novo aneurysms reported in Pubmed from 1985 to 2021 was systematically reviewed, and 18 case reports from 17 articles and 16 case series were identified. Univariate and multivariate analyses and modified Fisher test were used to analyze the relationship between pathogenic factors and prognosis. RESULTS Hypertension was noted in 60% of our clinical cases, 50% of the case series identified in the literature review, and 66.7% of the case reports in the literature review. In the case reports identified from our literature review, the proportion of original aneurysms in the anterior circulation was 96.3%. Moreover, in our 5 cases, all original aneurysms occurred in the anterior circulation. The rupture rate of original aneurysms in our 5 cases was 100%, and that of the cases reported in the literature review was 88.9%. Univariate logistic analysis showed that the time interval was related to the prognosis of de novo aneurysms with a P value of 0.048 and an odds ratio of 0.968 (95% confidence interval 0.938-1.000). Modified Fisher exact tests showed that patient age at the occurrence of de novo aneurysm P = 0.029) was related to the prognosis of de novo aneurysms. CONCLUSIONS Hypertension, an original aneurysms located in the anterior circulation and rupture represent the pathogenic factors associated with de novo aneurysms. The time interval to de novo aneurysm and patient age at the occurrence of de novo aneurysm are predictive of prognosis. Based on the above information, we can prevent and improve the prognosis of de novo aneurysms.
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