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Plourde G, Roumes H, Suissa L, Hirt L, Doche É, Pellerin L, Bouzier-Sore AK, Quintard H. Neuroprotective effects of lactate and ketone bodies in acute brain injury. J Cereb Blood Flow Metab 2024:271678X241245486. [PMID: 38603600 DOI: 10.1177/0271678x241245486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The goal of neurocritical care is to prevent and reverse the pathologic cascades of secondary brain injury by optimizing cerebral blood flow, oxygen supply and substrate delivery. While glucose is an essential energetic substrate for the brain, we frequently observe a strong decrease in glucose delivery and/or a glucose metabolic dysregulation following acute brain injury. In parallel, during the last decades, lactate and ketone bodies have been identified as potential alternative fuels to provide energy to the brain, both under physiological conditions and in case of glucose shortage. They are now viewed as integral parts of brain metabolism. In addition to their energetic role, experimental evidence also supports their neuroprotective properties after acute brain injury, regulating in particular intracranial pressure control, decreasing ischemic volume, and leading to an improvement in cognitive functions as well as survival. In this review, we present preclinical and clinical evidence exploring the mechanisms underlying their neuroprotective effects and identify research priorities for promoting lactate and ketone bodies use in brain injury.
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Affiliation(s)
- Guillaume Plourde
- Division of Intensive Care Medicine, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Hélène Roumes
- Centre de Résonance Magnétique des Systèmes Biologiques (CRMSB), Univ. Bordeaux, CNRS, CRMSB/UMR 5536, Bordeaux, France
| | | | - Lorenz Hirt
- Division of Neurology, Department of Clinical Neuroscience, Centre hospitalier universitaire vaudois, Lausanne, Suisse
| | - Émilie Doche
- Neurovascular Unit, CHU de Marseille, Marseille, France
| | - Luc Pellerin
- IRMETIST Inserm U1313, Université et CHU de Poitiers, Poitiers, France
| | - Anne-Karine Bouzier-Sore
- Centre de Résonance Magnétique des Systèmes Biologiques (CRMSB), Univ. Bordeaux, CNRS, CRMSB/UMR 5536, Bordeaux, France
| | - Hervé Quintard
- Division of Intensive Care Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Hôpitaux universitaires de Genéve, Genéve, Suisse
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2
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Pizzarotti B, Buhler-Heintze A, Allali G, Rouaud O, Bally J, Michel P, Hirt L, Théaudin M, Pot Kreis C, Ryvlin P, Sokolov A, Rossetti A, Novy J, Du Pasquier R. [Neurology: what's new in 2023]. Rev Med Suisse 2024; 20:72-75. [PMID: 38231105 DOI: 10.53738/revmed.2024.20.856-7.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The year 2023 is marked by the arrival on the market of lecanemab for the treatment of Alzheimer's disease. New biomarkers have demonstrated their usefulness in monitoring peripheral neuropathies and diagnosing synucleinopathies. A genetic study has highlighted the role of nervous system cells in the risk of progression of multiple sclerosis (MS). The adverse effects of anticonvulsant treatments after prenatal exposure and on lipid metabolism have been clarified. New anti-CGRP treatments have demonstrated their efficacy in migraine attacks and chronic migraines. The criteria for thrombectomy have been further broadened. And finally, rehabilitation is refining the management of cerebrovascular patients and those with secondary progressive MS.
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Affiliation(s)
- Beatrice Pizzarotti
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Amélie Buhler-Heintze
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gilles Allali
- Centre Leenaards de la mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Rouaud
- Centre Leenaards de la mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Julien Bally
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Caroline Pot Kreis
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Philippe Ryvlin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Arseny Sokolov
- Service de neuropsychologie et de neuroréhabilitation, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andrea Rossetti
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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3
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Lê T, Buscemi L, Lepore M, Mishkovsky M, Hyacinthe JN, Hirt L. Influence of DNP Polarizing Agents on Biochemical Processes: TEMPOL in Transient Ischemic Stroke. ACS Chem Neurosci 2023; 14:3013-3018. [PMID: 37603041 PMCID: PMC10485885 DOI: 10.1021/acschemneuro.3c00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Hyperpolarization of 13C by dissolution dynamic nuclear polarization (dDNP) boosts the sensitivity of magnetic resonance spectroscopy (MRS), making possible the monitoring in vivo and in real time of the biochemical reactions of exogenously infused 13C-labeled metabolic tracers. The preparation of a hyperpolarized substrate requires the use of free radicals as polarizing agents. Although added at very low doses, these radicals are not biologically inert. Here, we demonstrate that the presence of the nitroxyl radical TEMPOL influences significantly the cerebral metabolic readouts of a hyperpolarized [1-13C] lactate bolus injection in a mouse model of ischemic stroke with reperfusion. Thus, the choice of the polarizing agent in the design of dDNP hyperpolarized MRS experiments is of great importance and should be taken into account to prevent or to consider significant effects that could act as confounding factors.
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Affiliation(s)
- Thanh
Phong Lê
- Geneva
School of Health Sciences, HES-SO University
of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206 Geneva, Switzerland
- Laboratory
of Functional and Metabolic Imaging, Institute
of Physics, École Polytechnique Fédérale de Lausanne
(EPFL), Station 6, 1015 Lausanne, Switzerland
| | - Lara Buscemi
- Department
of Clinical Neurosciences, Lausanne University
Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Mario Lepore
- CIBM
Center for Biomedical Imaging, École
Polytechnique Fédérale de Lausanne (EPFL), Station 6, 1015 Lausanne, Switzerland
| | - Mor Mishkovsky
- Laboratory
of Functional and Metabolic Imaging, Institute
of Physics, École Polytechnique Fédérale de Lausanne
(EPFL), Station 6, 1015 Lausanne, Switzerland
| | - Jean-Noël Hyacinthe
- Geneva
School of Health Sciences, HES-SO University
of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206 Geneva, Switzerland
- Laboratory
of Functional and Metabolic Imaging, Institute
of Physics, École Polytechnique Fédérale de Lausanne
(EPFL), Station 6, 1015 Lausanne, Switzerland
- Image
Guided Intervention Laboratory, Faculty of Medicine, University of Geneva, HUG, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Lorenz Hirt
- Department
of Clinical Neurosciences, Lausanne University
Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
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4
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Bouvy C, Caranzano L, Allali G, Bally J, Benninger D, Beuchat I, Castro Jimenez M, Di Virgilio G, Hirt L, Michel P, Novy J, Pot Kreis C, Rossetti A, Rouaud O, Ryvlin P, Salvioni Chiabotti P, Sokolov A, Strambo D, Théaudin M, Du Pasquier R. [Neurology: what's new in 2022]. Rev Med Suisse 2023; 19:42-45. [PMID: 36660836 DOI: 10.53738/revmed.2023.19.809-10.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The year 2022 was marked by the development of numerous new treatments for refractory myasthenia gravis. The link between epilepsy and cerebrovascular disorder was studied and lamotrigine discovered to be the optimal treatment choice for epilepsy secondary to stroke to prevent mortality on patient of 45 years and older. New randomized study finally demonstrated the utility of thrombectomy in selected patients with basilar artery occlusion. The causal relationship between Epstein-Barr infection and multiple sclerosis has been proved thanks to a large cohort study. A new possibility of subcutaneous continuous levodopa administration gave promising result. Finally, numerous studies confirmed the efficacy and excellent tolerability of anti-CGRP antibodies.
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Affiliation(s)
- Céline Bouvy
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Leonardo Caranzano
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gilles Allali
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Julien Bally
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - David Benninger
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Isabelle Beuchat
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Mayté Castro Jimenez
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gabriella Di Virgilio
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Caroline Pot Kreis
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andrea Rossetti
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Rouaud
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Philippe Ryvlin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Paolo Salvioni Chiabotti
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Arseny Sokolov
- Service de neuropsychologie et de neuroréhabilitation, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Davide Strambo
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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5
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Bill O, Mazya MV, Michel P, Prazeres Moreira T, Lambrou D, Meyer IA, Hirt L. Intima-Media Thickness and Pulsatility Index of Common Carotid Arteries in Acute Ischaemic Stroke Patients with Diabetes Mellitus. J Clin Med 2022; 12:jcm12010246. [PMID: 36615047 PMCID: PMC9821495 DOI: 10.3390/jcm12010246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Ultrasonographic parameters such as the common carotid artery (CCA) pulsatility index (PI) and CCA intima-media thickness (IMT) have been associated with an increased mortality and risk of recurrent stroke, respectively. We hypothesized that these ultrasonographic parameters may be useful for monitoring diabetic patients after an acute stroke. We analysed retrospective data of consecutive acute ischaemic stroke patients from the ASTRAL registry who underwent pre-cerebral ultrasonographic evaluation within 7 days of symptom onset. We compared clinical, demographic, radiological and ultrasonographic parameters in diabetic versus non-diabetic patients (univariable and multivariable analyses) and the association of these parameters with CCA PI and CCA IMT. We analysed 1507 carotid duplex ultrasound examinations from patients with a median age of 74 years. Cardiovascular co-morbidities, including hypertension, hypercholesterolemia, obstructive sleep apnoea syndrome, higher body-mass index (BMI) and peripheral artery disease, were associated with diabetes mellitus (DM). Diabetics were more often under antiplatelet therapy and had atrial fibrillation at admission. Diabetic patients showed an increased CCA PI and IMT in line with more atherosclerotic changes on acute CTA compared to non-diabetic patients. Taking IMT as the dependent variable in a second analysis, DM, higher age, hypertension, smoking and CCA PI were associated with higher IMT. Taking CCA PI as the dependent variable in a third analysis, DM, higher age and higher NIHSS at admission were associated with higher CCA PI values. Increased IMT was also associated with higher PI. We show that CCA PI and IMT are higher in diabetic patients in the first week after an initial stroke.
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Affiliation(s)
- Olivier Bill
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: (O.B.); (L.H.)
| | - Michael V. Mazya
- Department of Neurology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Tiago Prazeres Moreira
- Department of Neurology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Dimitris Lambrou
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Ivo A. Meyer
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Department of Old Age Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland
| | - Lorenz Hirt
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: (O.B.); (L.H.)
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6
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Vicino A, Allali G, Bally J, Castro Jimenez M, Chiabotti Salvioni P, Hirt L, Hottinger A, Michel P, Novy J, Pot Kreis C, Rossetti A, Rouaud O, Ryvlin P, Théaudin M, Du Pasquier R. [Neurology : what's new in 2021]. Rev Med Suisse 2022; 18:51-55. [PMID: 35048580 DOI: 10.53738/revmed.2022.18.764-65.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In 2021, we assisted to the publication of new diagnostic criteria, classifications, and guidelines (CIDP, brain tumors, auto-immune encephalitis). Several studies helped to define the pharmacological management of focal and generalized epileptic seizures and epilepsy in pregnant women. The availability of biomarkers and the approval of immunotherapies are modifying the landscape of dementia management. Endovascular interventions without previous thrombolysis seems to be effective in anterior circulation acute ischemic stroke (AIS) and severe posterior circulation AIS. Neurologic complications of Sars-CoV-2 infection were further studied, as well as the efficacy of vaccines in immunosuppressed patients. New molecules and techniques show promising results for the treatment of migraine and cluster headache.
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Affiliation(s)
- Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gilles Allali
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Julien Bally
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Mayte Castro Jimenez
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Paolo Chiabotti Salvioni
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andreas Hottinger
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Caroline Pot Kreis
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andrea Rossetti
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Rouaud
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Philippe Ryvlin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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7
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Sztajzel RF, Engelter ST, Bonati LH, Mono M, Slezak A, Kurmann R, Nedeltchev K, Gensicke H, Traenka C, Baumgartner RW, Bonvin C, Hirt L, Medlin F, Burow A, Kägi G, Kapauer M, Vehoff J, Lovblad KO, Curtin F, Lyrer PA. Carotid plaque surface echogenicity predicts cerebrovascular events: An Echographic Multicentric Swiss Study. J Neuroimaging 2022; 32:1142-1152. [PMID: 35848388 PMCID: PMC9796934 DOI: 10.1111/jon.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort METHODS: Patients with ≥60% asymptomatic or ≥50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.5, and 0-2 mm of the outer border of the plaque. Red, yellow and green colour represented low, intermediate or high echogenicity. Proportion of red color on surface (PRCS) reflecting low echogenictiy was considered alone or combined to degree of stenosis (Risk index, RI). RESULTS We included 205 asymptomatic and 54 symptomatic patients. During follow-up (median/mean 24/27.7 months) 27 patients experienced stroke or TIA. In the asymptomatic group, RI ≥0.25 and PRCS ≥79% predicted stroke or TIA with a hazard ratio (HR) of respectively 8.7 p = 0.0001 and 10.2 p < 0.0001. In the symptomatic group RI ≥0.25 and PRCS ≥81% predicted stroke or TIA occurrence with a HR of respectively 6.1 p = 0.006 and 8.9 p = 0.001. The best surface parameter was located at 0-0.5mm. Among variables including age, sex, degree of stenosis, stenosis progression, RI, PRCS, grey median scale values and clinical baseline status, only PRCS independently prognosticated stroke (p = 0.005). CONCLUSION In this pilot study including patients with at least moderate degree of carotid stenosis, PRCS (0-0.5mm) alone or combined to degree of stenosis strongly predicted occurrence of subsequent cerebrovascular events.
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Affiliation(s)
- Roman F Sztajzel
- Department of Neurology and Stroke CenterUniversity Hospital Geneva and Medical School
| | - Stefan T Engelter
- University of Basel,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation
| | | | | | | | | | | | | | | | | | - Christophe Bonvin
- Department of Neurology and Stroke CenterUniversity Hospital Geneva and Medical School
| | | | | | | | - Georg Kägi
- Department of NeurologyCantonal Hospital and Stroke CenterSt. Gallen
| | - Monika Kapauer
- Department of NeurologyCantonal Hospital and Stroke CenterSt. Gallen
| | - Jochen Vehoff
- Department of NeurologyCantonal Hospital and Stroke CenterSt. Gallen
| | - Karl O Lovblad
- University Hospital Geneva and Medical School and Department of Neuroradiology
| | - Francois Curtin
- Felix Platter Hospital, Basel, Department of Clinical PharmacologyUniversity Hospital Geneva
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8
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Abstract
Background Emerging yet contrasting evidence from animal and human studies associates ischemic preconditioning with improvement of subsequent stroke severity, although long-term outcome remains unclear. The purpose of this study was to analyze how preceding cerebral ischemic events influence subsequent stroke severity and outcome. Methods and Results Data for this retrospective cohort study were extracted from ASTRAL (Acute Stroke Registry and Analysis of Lausanne). This registry includes a sample of all consecutive patients with acute ischemic strokes admitted to the stroke unit and/or intensive care unit of the Lausanne University Hospital, Switzerland. We investigated associations between preceding ischemic events (transient ischemic attacks or ischemic strokes) and the impact on subsequent stroke severity and clinical improvement within 24 hours, measured through National Institute of Health Stroke Scale, as well as 3-month outcome, determined through a shift in the modified Rankin Scale. Of 3530 consecutive patients with ischemic stroke (43% women, median age 73 years), 1001 (28%) had ≥1 preceding cerebral ischemic events (45% transient ischemic attack, 55% ischemic stroke; 31% multiple events). After adjusting for multiple prehospital, clinical, and laboratory confounders, admission stroke severity was significantly lower in patients preconditioned through a preceding ischemic event, but 24-hour improvement was not significant and 3-month outcome was unfavorable. Conclusions Preceding ischemic events were independently associated with a significant reduction in subsequent stroke severity but worsened long-term clinical outcome. These results, if confirmed by future randomized studies, may help design neuroprotective strategies. The unfavorable effect on stroke outcome is probably a consequence of the cumulative disability burden after multiple ischemic events.
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Affiliation(s)
- Pamela N Correia
- Neurology Service Stroke Center Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland.,Stroke Unit Neurology Service Cantonal Hospital of Biel Biel Switzerland
| | - Ivo A Meyer
- Neurology Service Stroke Center Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Ashraf Eskandari
- Neurology Service Stroke Center Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Michael Amiguet
- Center for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Lorenz Hirt
- Neurology Service Stroke Center Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
| | - Patrik Michel
- Neurology Service Stroke Center Department of Clinical Neurosciences Lausanne University Hospital Lausanne Switzerland
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9
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Buscemi L, Blochet C, Magistretti PJ, Hirt L. Hydroxycarboxylic Acid Receptor 1 and Neuroprotection in a Mouse Model of Cerebral Ischemia-Reperfusion. Front Physiol 2021; 12:689239. [PMID: 34093243 PMCID: PMC8176103 DOI: 10.3389/fphys.2021.689239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Lactate is an intriguing molecule with emerging physiological roles in the brain. It has beneficial effects in animal models of acute brain injuries and traumatic brain injury or subarachnoid hemorrhage patients. However, the mechanism by which lactate provides protection is unclear. While there is evidence of a metabolic effect of lactate providing energy to deprived neurons, it can also activate the hydroxycarboxylic acid receptor 1 (HCAR1), a Gi-coupled protein receptor that modulates neuronal firing rates. After cerebral hypoxia-ischemia, endogenously produced brain lactate is largely increased, and the exogenous administration of more lactate can decrease lesion size and ameliorate the neurological outcome. To test whether HCAR1 plays a role in lactate-induced neuroprotection, we injected the agonists 3-chloro-5-hydroxybenzoic acid and 3,5-dihydroxybenzoic acid into mice subjected to 30-min middle cerebral artery occlusion. The in vivo administration of HCAR1 agonists at reperfusion did not appear to exert any relevant protective effect as seen with lactate administration. Our results suggest that the protective effects of lactate after hypoxia-ischemia come rather from the metabolic effects of lactate than its signaling through HCAR1.
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Affiliation(s)
- Lara Buscemi
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Camille Blochet
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Pierre J Magistretti
- Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Lorenz Hirt
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
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10
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Michel P, Hirt L, Strambo D. [COVID-19 and stroke: associated or not ?]. Rev Med Suisse 2021; 17:816-821. [PMID: 33908717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 patients are at a higher risk of stroke. This observation is in apparent contradiction with the reduced number of stroke patient admissions during the first wave of the COVID-19 pandemic, seen worldwide. The SARS-CoV-2 can affect the endothelium, favour a procoagulant state and involves the heart, leading to an increased risk of developing a stroke. The pandemic and confinement influence the behaviour of the population, perhaps more reticent to contact emergency departments flooded with COVID-19 patients and likely to have modified levels of stress. In addition, it was shown that confinement during the pandemic reduced air pollution, thought to affect stroke risk. These indirect effects of SARS-CoV-2 probably also impact the number of hospital admissions for stroke. These different aspects are presented here as a controversy.
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Affiliation(s)
- Patrik Michel
- Centre cérébrovasculaire, Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Lorenz Hirt
- Centre cérébrovasculaire, Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Davide Strambo
- Centre cérébrovasculaire, Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
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11
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Anichini A, Salvioni Chiabotti P, Bally J, Castro Jimenez M, Démonet JF, Di Virgilio G, Hirt L, Hottinger A, Kuntzer T, Michel P, Novy J, Pot Kreis C, Rossetti AO, Rouaud O, Théaudin M, Du Pasquier R. [Recent Advances in Neurology]. Rev Med Suisse 2021; 17:196-200. [PMID: 33507660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Significant developments were published in 2020 in the field of blood biomarkers in Alzheimer's disease. Several studies helped to define more accurately the management of status epilepticus and of epilepsy in women of childbearing age. The new Swiss guidelines for the pre-hospital management of acute stroke were issued, as are new targets for stroke prevention. Numerous advances concerning the management of NMO-SD (NeuroMyelitis Optica Spectrum Disorder) were published. Different neurological presentations linked to the COVID-19 pandemic were described (central and peripheral). Several studies confirmed the effectiveness of new migraine treatments (including anti-CGRP). New pharmacological therapies are available for Parkinson's disease.
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Affiliation(s)
- Angelica Anichini
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | | | - Julien Bally
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Mayte Castro Jimenez
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Jean-François Démonet
- Centre Leenaards de la mémoire, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | | | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Andreas Hottinger
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Thierry Kuntzer
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Caroline Pot Kreis
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Andrea O Rossetti
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Olivier Rouaud
- Centre Leenaards de la mémoire, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
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12
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Bill O, Lambrou D, Sotomayor GT, Meyer I, Michel P, Moreira T, Niederhauser J, Hirt L. Predictors of the pulsatility index in the middle cerebral artery of acute stroke patients. Sci Rep 2020; 10:17110. [PMID: 33051499 PMCID: PMC7554045 DOI: 10.1038/s41598-020-74056-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/25/2020] [Indexed: 01/15/2023] Open
Abstract
Cervical and transcranial Doppler (TCD) are widely used as non-invasive methods in the evaluation of acute ischemic stroke (AIS) patients. High-grade carotid artery stenosis induces haemodynamic changes such as collateral flow and a so-called post-stenotic flow pattern of the middle cerebral artery (MCA), which appears flattened, with a reduction of the velocity difference between systole and diastole. We studied the influence of carotid artery stenosis and other variables on the flow pattern in the MCA using the pulsatility index (PI), a quantitative TCD parameter reflecting the flow spectrum in a large of cohort AIS patients. We performed ultrasound examinations of 1825 AIS patients at the CHUV from October 2004 to December 2014. We extracted patient characteristics from the ASTRAL registry. Carotid stenosis severity was classified as < 50%, 50–70%, 70–90% and > 90%, or occlusion, according to Doppler velocity criteria. We first determined variables associated with stenosis grade. Then we performed a multivariate analysis after adjusting for baseline differences, using MCA PI as dependent variable. Carotid stenosis > 70% (− 0.07) and carotid stenosis > 90%, or occlusion (− 0.14) and left side (− 0.02) are associated with lower MCA PI values. Age (+0.006 PI units per decade), diabetes (+0.07), acute ischemic changes on initial CT (+0.03) and severe plaque morphology (+0.18) are associated with higher MCA PI values. We found a number of clinical and radiological conditions that significantly influence the PI of the MCA, including high-grade ipsilateral carotid stenosis in AIS patients. We provide for the first time a quantitative evaluation of the effect of these influencing factors from a large cohort of AIS patients.
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Affiliation(s)
- Olivier Bill
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Bugnon 46, 1011, Lausanne, Switzerland.
| | - Dimitris Lambrou
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Bugnon 46, 1011, Lausanne, Switzerland
| | | | - Ivo Meyer
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Bugnon 46, 1011, Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Bugnon 46, 1011, Lausanne, Switzerland
| | - Tiago Moreira
- Department of Neurology, Karolinska Stroke Research Unit, Karolinska University Hospital-Solna, Stockholm, Sweden
| | | | - Lorenz Hirt
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Bugnon 46, 1011, Lausanne, Switzerland
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13
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Filchenko I, Blochet C, Buscemi L, Price M, Badaut J, Hirt L. Caveolin-1 Regulates Perivascular Aquaporin-4 Expression After Cerebral Ischemia. Front Cell Dev Biol 2020; 8:371. [PMID: 32523952 PMCID: PMC7261922 DOI: 10.3389/fcell.2020.00371] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 01/25/2023] Open
Abstract
Edema is a hallmark of many brain disorders including stroke. During vasogenic edema, blood-brain barrier (BBB) permeability increases, contributing to the entry of plasma proteins followed by water. Caveolae and caveolin-1 (Cav-1) are involved in these BBB permeability changes. The expression of the aquaporin-4 (AQP4) water channel relates to brain swelling, however, its regulation is poorly understood. Here we tested whether Cav-1 regulates AQP4 expression in the perivascular region after brain ischemia in mice. We showed that Cav-1 knockout mice had enhanced hemispheric swelling and decreased perivascular AQP4 expression in perilesional and contralateral cortical regions compared to wild-type. Glial fibrillary acidic protein-positive astrocytes displayed less branching and ramification in Cav-1 knockout mice compared to wild-type animals. There was a positive correlation between the area of perivascular AQP4-immunolabelling and branch length of Glial fibrillary acidic protein-positive astrocytes in wild-type mice, not seen in Cav-1 knockout mice. In summary, we show for the first time that loss of Cav-1 results in decreased AQP4 expression and impaired perivascular AQP4 covering after cerebral ischemia associated with altered reactive astrocyte morphology and enhanced brain swelling. Therapeutic approaches targeting Cav-1 may provide new opportunities for improving stroke outcome.
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Affiliation(s)
- Irina Filchenko
- Service of Neurology, Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Camille Blochet
- Service of Neurology, Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Lara Buscemi
- Service of Neurology, Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Melanie Price
- Service of Neurology, Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Jerome Badaut
- Brain Molecular Imaging Lab, CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France.,Basic Science Department, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Lorenz Hirt
- Service of Neurology, Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
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14
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Hyacinthe JN, Buscemi L, Lê TP, Lepore M, Hirt L, Mishkovsky M. Evaluating the potential of hyperpolarised [1- 13C] L-lactate as a neuroprotectant metabolic biosensor for stroke. Sci Rep 2020; 10:5507. [PMID: 32218474 PMCID: PMC7099080 DOI: 10.1038/s41598-020-62319-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/05/2020] [Indexed: 01/06/2023] Open
Abstract
Cerebral metabolism, which can be monitored by magnetic resonance spectroscopy (MRS), changes rapidly after brain ischaemic injury. Hyperpolarisation techniques boost 13C MRS sensitivity by several orders of magnitude, thereby enabling in vivo monitoring of biochemical transformations of hyperpolarised (HP) 13C-labelled precursors with a time resolution of seconds. The exogenous administration of the metabolite L-lactate was shown to decrease lesion size and ameliorate neurological outcome in preclinical studies in rodent stroke models, as well as influencing brain metabolism in clinical pilot studies of acute brain injury patients. The aim of this study was to demonstrate the feasibility of measuring HP [1-13C] L-lactate metabolism in real-time in the mouse brain after ischaemic stroke when administered after reperfusion at a therapeutic dose. We showed a rapid, time-after-reperfusion-dependent conversion of [1-13C] L-lactate to [1-13C] pyruvate and [13C] bicarbonate that brings new insights into the neuroprotection mechanism of L-lactate. Moreover, this study paves the way for the use of HP [1-13C] L-lactate as a sensitive molecular-imaging biosensor in ischaemic stroke patients after endovascular clot removal.
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Affiliation(s)
- Jean-Noël Hyacinthe
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Image Guided Intervention Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lara Buscemi
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thanh Phong Lê
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Laboratory of Functional and Metabolic Imaging, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mario Lepore
- Centre d'Imagerie Biomédicale (CIBM), École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Lorenz Hirt
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mor Mishkovsky
- Laboratory of Functional and Metabolic Imaging, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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15
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Buscemi L, Blochet C, Price M, Magistretti PJ, Lei H, Hirt L. Extended preclinical investigation of lactate for neuroprotection after ischemic stroke. Clinical and Translational Neuroscience 2020. [DOI: 10.1177/2514183x20904571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lactate has been shown to have beneficial effect both in experimental ischemia–reperfusion models and in human acute brain injury patients. To further investigate lactate’s neuroprotective action in experimental in vivo ischemic stroke models prior to its use in clinics, we tested (1) the outcome of lactate administration on permanent ischemia and (2) its compatibility with the only currently approved drug for the treatment of acute ischemic stroke, recombinant tissue plasminogen activator (rtPA), after ischemia–reperfusion. We intravenously injected mice with 1 µmol/g sodium l-lactate 1 h or 3 h after permanent middle cerebral artery occlusion (MCAO) and looked at its effect 24 h later. We show a beneficial effect of lactate when administered 1 h after ischemia onset, reducing the lesion size and improving neurological outcome. The weaker effect observed at 3 h could be due to differences in the metabolic profiles related to damage progression. Next, we administered 0.9 mg/kg of intravenous (iv) rtPA, followed by intracerebroventricular injection of 2 µL of 100 mmol/L sodium l-lactate to treat mice subjected to 35-min transient MCAO and compared the outcome (lesion size and behavior) of the combined treatment with that of single treatments. The administration of lactate after rtPA has positive influence on the functional outcome and attenuates the deleterious effects of rtPA, although not as strongly as lactate administered alone. The present work gives a lead for patient selection in future clinical studies of treatment with inexpensive and commonly available lactate in acute ischemic stroke, namely patients not treated with rtPA but mechanical thrombectomy alone or patients without recanalization therapy.
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Affiliation(s)
- Lara Buscemi
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Camille Blochet
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Melanie Price
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Pierre J Magistretti
- Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
- Department of Psychiatry, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - Hongxia Lei
- Center for Biomedical Imaging (CIBM), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Lorenz Hirt
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
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16
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Perrenoud M, Pantazou V, Michel P, Hirt L, Ryvlin P, Theaudin M, Rouaud O, Benninger D, Novy J, Rossetti AO, Kuntzer T, Diserens K, Pasquier RD. [Neurology 2019]. Rev Med Suisse 2020; 16:68-71. [PMID: 31961088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
New studies confirm the possibility of late thrombolysis. Meta-analyses have confirmed that CGRP inhibitors are efficacious for migraines. Cladribine is a new oral treatment for relapsing-remitting multiple sclerosis. Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a new clinical entity accounting for cognitive decline in old patients. The timing of levodopa introduction has no effect on the long-term course of idiopathic Parkinson's disease. Hypophosphatemia helps distinguish between seizures and syncopes in the emergency department. A second course of intravenous immunoglobulins provides no benefit for severe Guillain Barre syndrome. Outdoor therapy improves clinical scales in patients with disorder of consciousness. Ultrasound guided lumbar puncture improves the yield of the procedure.
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Affiliation(s)
- Matthieu Perrenoud
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Vasiliki Pantazou
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Patrik Michel
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Lorenz Hirt
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Philippe Ryvlin
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Marie Theaudin
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Olivier Rouaud
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - David Benninger
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Jan Novy
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Andrea O Rossetti
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Thierry Kuntzer
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Karin Diserens
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Renaud Du Pasquier
- Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
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17
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Blochet C, Buscemi L, Clément T, Gehri S, Badaut J, Hirt L. Involvement of caveolin-1 in neurovascular unit remodeling after stroke: Effects on neovascularization and astrogliosis. J Cereb Blood Flow Metab 2020; 40:163-176. [PMID: 30354902 PMCID: PMC6928561 DOI: 10.1177/0271678x18806893] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complex cellular and molecular events occur in the neurovascular unit after stroke, such as blood-brain barrier (BBB) dysfunction and inflammation that contribute to neuronal death, neurological deterioration and mortality. Caveolin-1 (Cav-1) has distinct physiological functions such as caveolae formation associated with endocytosis and transcytosis as well as in signaling pathways. Cav-1 has been proposed to be involved in BBB dysfunction after brain injury; however, its precise role is poorly understood. The goal of this study was to characterize the expression and effect of Cav-1 deletion on outcome in the first week in a transient Middle Cerebral Artery Occlusion stroke model. We found increased Cav-1 expression in new blood vessels in the lesion and in reactive astrocytes in the peri-lesion areas. In Cav-1 KO mice, the lesion volume was larger and the behavioral outcome worse than in WT mice. Cav-1 KO mice exhibited reduced neovascularization and modified astrogliosis, without formation of a proper glial scar around the lesion at three days post injury, coinciding with aggravated outcomes. Altogether, these results point towards a potential protective role of endogenous Cav-1 in the first days after ischemia by promoting neovascularization, astrogliosis and scar formation.
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Affiliation(s)
- Camille Blochet
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Brain Molecular Imaging Lab, CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France
| | - Lara Buscemi
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Tifenn Clément
- Brain Molecular Imaging Lab, CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France
| | - Sabrina Gehri
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Jérôme Badaut
- Brain Molecular Imaging Lab, CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France.,Basic Science Department, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Lorenz Hirt
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
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18
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Lepore MG, Buscemi L, Hirt L, Lei H. Metabolic fingerprints discriminating severity of acute ischemia using in vivo high-field 1 H magnetic resonance spectroscopy. J Neurochem 2019; 152:252-262. [PMID: 31758862 DOI: 10.1111/jnc.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Abstract
Despite the improving imaging techniques, it remains challenging to produce magnetic resonance (MR) imaging fingerprints depicting severity of acute ischemia. The aim of this study was to evaluate the potential of the overall high-field 1 H MR Spectroscopy (1 H-MRS) neurochemical profile as a metabolic signature for acute ischemia severity in rodent brains. We modeled global ischemia with one-stage 4-vessel-occlusion (4VO) in rats. Vascular structures were assessed immediately by magnetic resonance angiography. The neurochemical responses in the bilateral cortex were measured 1 h after stroke onset by 1 H-MRS. Then we used Partial-Least-Squares discriminant analysis on the overall neurochemical profiles to seek metabolic signatures for ischemic severity subgroups. This approach was further tested on neurochemical profiles of mouse striatum 1 h after permanent middle cerebral artery occlusion, where vascular blood flow was monitored by laser Doppler. Magnetic resonance angiography identified successful 4VO from controls and incomplete global ischemia (e.g., 3VO). 1 H-MR spectra of rat cortex after 4VO showed a specific metabolic pattern, distinct from that of respective controls and rats with 3VO. Partial-Least-Squares discriminant analysis on the overall neurochemical profiles revealed metabolic signatures of acute ischemia that may be extended to mice after permanent middle cerebral artery occlusion. Fingerprinting severity of acute ischemia using neurochemical information may improve MR diagnosis in stroke patients.
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Affiliation(s)
- Mario G Lepore
- Animal Imaging and Technology Core (AIT), Center for Biomedical Imaging (CIBM), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Lara Buscemi
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Lorenz Hirt
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Hongxia Lei
- Animal Imaging and Technology Core (AIT), Center for Biomedical Imaging (CIBM), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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19
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Michel P, Mösinger D, Hirt L, Arnold M. Conference spotlight: 21st Annual Meeting of the Swiss Stroke Society, the 1st Symposium of the Swiss Stroke Nursing Network and the Swiss Stroke Trialists’ Meeting. Clinical and Translational Neuroscience 2019. [DOI: 10.1177/2514183x18822125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The 21st Annual Meeting of the Swiss Stroke Society held in Lausanne, Switzerland, from the 11th to 12th January 2018 at Lausanne University Hospital (CHUV) included scientific sessions about vasculitis, hyperacute stroke management, the old and polymorbid stroke patient, and cerebral aneurysms/vasospasms and inaugurated the 1st Symposium of the Swiss Stroke Nursing Network.
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Affiliation(s)
- Patrik Michel
- Departement universitaire de medecine et sante communautaires, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Doris Mösinger
- Cereneo AG, Center for Neurology and Rehabilitation, Vitznau
| | - Lorenz Hirt
- Departement universitaire de medecine et sante communautaires, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern
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20
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Buscemi L, Price M, Bezzi P, Hirt L. Spatio-temporal overview of neuroinflammation in an experimental mouse stroke model. Sci Rep 2019; 9:507. [PMID: 30679481 PMCID: PMC6345915 DOI: 10.1038/s41598-018-36598-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
After ischemic stroke, in the lesion core as well as in the ischemic penumbra, evolution of tissue damage and repair is strongly affected by neuroinflammatory events that involve activation of local specialized glial cells, release of inflammatory mediators, recruiting of systemic cells and vascular remodelling. To take advantage of this intricate response in the quest to devise new protective therapeutic strategies we need a better understanding of the territorial and temporal interplay between stroke-triggered inflammatory and cell death-inducing processes in both parenchymal and vascular brain cells. Our goal is to describe structural rearrangements and functional modifications occurring in glial and vascular cells early after an acute ischemic stroke. Low and high scale mapping of the glial activation on brain sections of mice subjected to 30 minutes middle cerebral artery occlusion (MCAO) was correlated with that of the neuronal cell death, with markers for microvascular changes and with markers for pro-inflammatory (IL-1β) and reparative (TGFβ1) cytokines. Our results illustrate a time-course of the neuroinflammatory response starting at early time-points (1 h) and up to one week after MCAO injury in mice, with an accurate spatial distribution of the observed phenomena.
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Affiliation(s)
- Lara Buscemi
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, University Hospital Centre and University of Lausanne, CH-1011, Lausanne, Switzerland. .,Department of Fundamental Neurosciences, University of Lausanne, CH-1005, Lausanne, Switzerland.
| | - Melanie Price
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, University Hospital Centre and University of Lausanne, CH-1011, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, CH-1005, Lausanne, Switzerland
| | - Paola Bezzi
- Department of Fundamental Neurosciences, University of Lausanne, CH-1005, Lausanne, Switzerland
| | - Lorenz Hirt
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, University Hospital Centre and University of Lausanne, CH-1011, Lausanne, Switzerland.,Department of Fundamental Neurosciences, University of Lausanne, CH-1005, Lausanne, Switzerland
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21
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Eskioglou E, Benninger D, Di Virgilio G, Hirt L, Kuntzer T, Michel P, Novy J, Rossetti AO, Rouaud O, Ryvlin P, Theaudin M, Du Pasquier R. [Neurology]. Rev Med Suisse 2019; 15:74-77. [PMID: 30629375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Thrombolysis and late thrombectomy can be performed in case of compatible radiological imaging. Anti-CGRP monoclonal antibodies seem more effective for the treatment of migraine. Siponimod can reduce significantly disability progression in secondarily progressive MS. Brand-to-generic levetiracetam switching does not cause recrudescence of epileptic seizures. A new definition of Alzheimer's disease using biomarkers of cerebrospinal fluid (CSF) and imaging provides a better understanding of the underlying mechanisms. The use of levodopa-carbidopa intestinal gel and a subcutaneous apomorphine infusion allow a reduction of motor fluctuations in Parkinson's disease. Eculizumab appears as an alternative treatment in severe forms of myasthenia gravis.
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Affiliation(s)
- Elissavet Eskioglou
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - David Benninger
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | | | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Thierry Kuntzer
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Andrea O Rossetti
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Olivier Rouaud
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Philippe Ryvlin
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Marie Theaudin
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
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22
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Downie P, Hirt L, Gritzmacher L, Johnson T, Bayly G. Assessment of Lp(a) and detection of monogenic and polygenic hypercholesterolaemia in a cohort of patients presenting with an acute coronary syndrome. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Affiliation(s)
- Lorenz Hirt
- Neurology service, department of clinical neurosciences, CHUV, Lausanne, Switzerland
- Centre de recherche en neurosciences (CRN), CHUV, Lausanne, Switzerland
| | - Melanie Price
- Neurology service, department of clinical neurosciences, CHUV, Lausanne, Switzerland
- Centre de recherche en neurosciences (CRN), CHUV, Lausanne, Switzerland
| | - Corinne Benakis
- Institute for Stroke and Dementia Research (ISD), Munich, Germany
| | - Jérôme Badaut
- CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France
- Department of Basic science, Loma Linda University, Loma Linda, CA, USA
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24
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Chopard I, Benninger D, Demonet JF, Du Pasquier R, Hirt L, Kuntzer T, Michel P, Nater B, Novy J, Rossetti A, Rouaud O, Ryvlin P, Schluep M, Theaudin M. [Neurology]. Rev Med Suisse 2018; 14:58-61. [PMID: 29337452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ocrelizumab (Ocrevus), an anti-CD20 monoclonal antibody, has been approved for the treatment of multiple sclerosis. Eculizumab (Soliris) has been approved in several countries for refractory forms of generalized seropositive severe myasthenia gravis. A form of gene therapy, patisiran, has shown positive results in transthyretin familial amyloidosis. In the treatment of headaches, particularly migraines, non-pharmacological approaches have shown some interesting results. The criteria for Lewy body dementia have been revised. Generic use of lamotrigine does not result in recrudescence of epileptic seizures or adverse effects.
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Affiliation(s)
- Isabelle Chopard
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - David Benninger
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | | | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Thierry Kuntzer
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Bernard Nater
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Andrea Rossetti
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Olivier Rouaud
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Philippe Ryvlin
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Myriam Schluep
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Marie Theaudin
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
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25
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Carrera E, Hirt L, Sztajzel R, Michel P, Kleinschmidt A, Du Pasquier R. [Not Available]. Rev Med Suisse 2017; 13:883-884. [PMID: 28727353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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26
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Sirimarco G, Hirt L, Sztajzel R, Perren F. [Stroke prevention in patients with atrial fibrillation]. Rev Med Suisse 2017; 13:911-915. [PMID: 28727359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Oral anticoagulation with vitamin K antagonists (VKA) was the cornerstone of stroke prevention in atrial fibrillation (AF). This review article presents the state of the art, with regard to the treatment options developed over the past few years, the new oral anticoagulants (NOAC). A search in PubMed for relevant published studies has been performed. Dabigatran and apixaban were superior to warfarin to reduce stroke risk or systemic embolism ; dabigatran, rivaroxaban and edoxaban were non-inferior. All NOAC are globally non-inferior to warfarin for stroke prevention in non-valvular AF and they have a superior safety profile, with a reduced intracranial bleeding risk. They are now the first choice for treatment.
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Affiliation(s)
- Gaia Sirimarco
- Stroke Center, Service de neurologie, Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Lorenz Hirt
- Stroke Center, Service de neurologie, Département des neurosciences cliniques, CHUV et Université de Lausanne, 1011 Lausanne
| | - Roman Sztajzel
- Unités de neurosonologie et neurologie vasculaire, Division de neurologie, Département des neurosciences cliniques, HUG et Faculté de médecine, 1211 Genève 14
| | - Fabienne Perren
- Unités de neurosonologie et neurologie vasculaire, Division de neurologie, Département des neurosciences cliniques, HUG et Faculté de médecine, 1211 Genève 14
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27
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Hirt L, Carrera E. [Antiplatelet therapy in secondary stroke prevention]. Rev Med Suisse 2017; 13:907-910. [PMID: 28727358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
New studies have refined the role of antiplatelet therapy in secondary prevention after noncardioembolic strokes. The first line antiplatelet therapy remains Aspirin. Clopidogrel and the combination aspirine plus dipyridamole are suitable alternatives with a slightly better protection. Ticagrelor, a reversible P2Y12 receptor inhibitor used in cardiology, has not demonstrated its superiority to Aspirin. Early after stroke, a double antiplatelet therapy combining Aspirin and clopidogrel is increasingly administered as a recent study demonstrated a decrease in the incidence of cerebrovascular events after a minor stroke or high-risk TIA. This benefit is particularly high in patients with severe atherosclerotic disease. The duration of the double antiplatelet therapy should not exceed three months to reduce the haemorrhagic risk.
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Affiliation(s)
- Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Emmanuel Carrera
- Service de neurologie, Département des neurosciences cliniques, HUG, 1211 Genève 14
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28
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Hirt L, Price M, Mastour N, Brunet JF, Barrière G, Friscourt F, Badaut J. Increase of aquaporin 9 expression in astrocytes participates in astrogliosis. J Neurosci Res 2017; 96:194-206. [PMID: 28419510 DOI: 10.1002/jnr.24061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 01/01/2023]
Abstract
Here we assess the potential functional role of increased aquaporin 9 (APQ9) in astrocytes. Increased AQP9 expression was achieved in primary astrocyte cultures by transfection of a plasmid-containing green fluorescent protein fused to either wild-type or mutated human AQP9. Increased AQP9 expression and phosphorylation at Ser222 were associated with a significant change in astrocyte morphology, mainly with a higher number of processes. Similar phenotypic changes are observed in astrogliosis processes after injury. In parallel, we observed that in vivo, thrombin preconditioning before ischemic stroke induced an early increase in AQP9 expression in the male mouse brain. This increased AQP9 expression was also associated with astrocyte morphological changes, especially in the white matter tract. Astrocyte reactivity is debated as being either beneficial or deleterious. As thrombin preconditioning leads to a decrease in lesion size after stroke, our data suggest that the early increase in AQP9 concomitant with astrocyte reactivity leads to a beneficial effect. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Lorenz Hirt
- Neurology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Melanie Price
- Neurology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Nabil Mastour
- Neurosurgery Research Group, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Brunet
- Neurosurgery Research Group, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | - Jerome Badaut
- CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France
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29
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Buscemi L, Ginet V, Lopatar J, Montana V, Pucci L, Spagnuolo P, Zehnder T, Grubišić V, Truttman A, Sala C, Hirt L, Parpura V, Puyal J, Bezzi P. Homer1 Scaffold Proteins Govern Ca2+ Dynamics in Normal and Reactive Astrocytes. Cereb Cortex 2017; 27:2365-2384. [PMID: 27075036 PMCID: PMC5963825 DOI: 10.1093/cercor/bhw078] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In astrocytes, the intracellular calcium (Ca2+) signaling mediated by activation of metabotropic glutamate receptor 5 (mGlu5) is crucially involved in the modulation of many aspects of brain physiology, including gliotransmission. Here, we find that the mGlu5-mediated Ca2+ signaling leading to release of glutamate is governed by mGlu5 interaction with Homer1 scaffolding proteins. We show that the long splice variants Homer1b/c are expressed in astrocytic processes, where they cluster with mGlu5 at sites displaying intense local Ca2+ activity. We show that the structural and functional significance of the Homer1b/c-mGlu5 interaction is to relocate endoplasmic reticulum (ER) to the proximity of the plasma membrane and to optimize Ca2+ signaling and glutamate release. We also show that in reactive astrocytes the short dominant-negative splice variant Homer1a is upregulated. Homer1a, by precluding the mGlu5-ER interaction decreases the intensity of Ca2+ signaling thus limiting the intensity and the duration of glutamate release by astrocytes. Hindering upregulation of Homer1a with a local injection of short interfering RNA in vivo restores mGlu5-mediated Ca2+ signaling and glutamate release and sensitizes astrocytes to apoptosis. We propose that Homer1a may represent one of the cellular mechanisms by which inflammatory astrocytic reactions are beneficial for limiting brain injury.
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Affiliation(s)
- Lara Buscemi
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, University Hospital Centre and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Vanessa Ginet
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
- Division of Neonatology, Department of Paediatrics and Paediatric Surgery, University Hospital Centre and University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Jan Lopatar
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
| | - Vedrana Montana
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
- Department of Neurobiology, Center for Glial Biology in Medicine, Civitan International Research Center, Atomic Force Microscopy and Nanotechnology Laboratories, and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luca Pucci
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
| | - Paola Spagnuolo
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Tamara Zehnder
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
| | - Vladimir Grubišić
- Department of Neurobiology, Center for Glial Biology in Medicine, Civitan International Research Center, Atomic Force Microscopy and Nanotechnology Laboratories, and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anita Truttman
- Division of Neonatology, Department of Paediatrics and Paediatric Surgery, University Hospital Centre and University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Carlo Sala
- CNR Institute of Neuroscience and Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Lorenz Hirt
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, University Hospital Centre and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Vladimir Parpura
- Department of Neurobiology, Center for Glial Biology in Medicine, Civitan International Research Center, Atomic Force Microscopy and Nanotechnology Laboratories, and Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julien Puyal
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
- Division of Neonatology, Department of Paediatrics and Paediatric Surgery, University Hospital Centre and University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Paola Bezzi
- Department of Fundamental Neurosciences, University of Lausanne, CH1005Lausanne, Switzerland
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30
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Maulucci F, Benninger D, Démonet JF, Du Pasquier RA, Hirt L, Hottinger A, Kuntzer T, Michel P, Nater B, Novy J, Rossetti AO, Schluep M, Vingerhoets FJG. [Neurology]. Rev Med Suisse 2017; 13:79-83. [PMID: 28703543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aducanumab reduces the burden of amyloid plaques in Alzheimer's disease, with significant improvement of clinical scores. Endovascular thrombectomy is recommended in patients with acute stroke with proximal occlusion of the anterior circulation. CGRP antagonists and botulinum toxin are effective in migraine. ZIKA virus infection has been linked to the Guillain-Barré syndrome. Edaravone has been approved for amyotrophic lateral sclerosis. Two monoclonal antibodies (ocrelizumab and daclizumab) and siponimod show positive results in multiple sclerosis. Thalamotomy of ventral intermediate nucleus (by gamma-knife or by magnetic resonance-guided focused ultrasound) is effective in drug-resistant essential tremor. The dose-dependent risk of foetal malformations associated with valproate and topiramate is confirmed.
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Affiliation(s)
- Francesco Maulucci
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - David Benninger
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | | | - Renaud A Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Andreas Hottinger
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Thierry Kuntzer
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Bernard Nater
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Andrea O Rossetti
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
| | - Myriam Schluep
- Service de neurologie, Département des neurosciences cliniques, CHUV, 1011 Lausanne
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31
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Hirt L, Fukuda AM, Ambadipudi K, Rashid F, Binder D, Verkman A, Ashwal S, Obenaus A, Badaut J. Improved long-term outcome after transient cerebral ischemia in aquaporin-4 knockout mice. J Cereb Blood Flow Metab 2017; 37:277-290. [PMID: 26767580 PMCID: PMC5363745 DOI: 10.1177/0271678x15623290] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 01/07/2023]
Abstract
A hallmark of stroke is water accumulation (edema) resulting from dysregulation of osmotic homeostasis. Brain edema contributes to tissue demise and may lead to increased intracranial pressure and lethal herniation. Currently, there are only limited treatments to prevent edema formation following stroke. Aquaporin 4 (AQP4), a brain water channel, has become a focus of interest for therapeutic approaches targeting edema. At present, there are no pharmacological tools to block AQP4. The role of AQP4 in edema after brain injury remains unclear with conflicting results from studies using AQP4-/- mice and of AQP4 expression following stroke. Here, we studied AQP4 and its role in edema formation by testing AQP4-/- mice in a model of middle cerebral artery occlusion using novel quantitative MRI water content measurements, histology and behavioral changes as outcome measures. Absence of AQP4 was associated with decreased mortality and increased motor recovery 3 to 14 days after stroke. Behavioral improvement was associated with decreased lesion volume, neuronal cell death and neuroinflammation in AQP4-/- compared to wild type mice. Our data suggest that the lack of AQP4 confers an overall beneficial role at long term with improved neuronal survival and reduced neuroinflammation, but without a direct effect on edema formation.
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Affiliation(s)
- Lorenz Hirt
- Department of Clinical Neurosciences, Neurology Service, Centre Hospitalier Universitaire Vaudois and Lausanne University, Switzerland
| | - Andrew M Fukuda
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kamalakar Ambadipudi
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Faisil Rashid
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Devin Binder
- Center for Glial-Neuronal Interactions, Division of Biomedical Sciences, University of California, Riverside, Riverside, CA, USA
| | - Alan Verkman
- Medicine and Physiology, Cardiovascular Research Institute, University of California San Francisco, CA, USA
| | - Stephen Ashwal
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andre Obenaus
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA.,Center for Glial-Neuronal Interactions, Division of Biomedical Sciences, University of California, Riverside, Riverside, CA, USA
| | - Jerome Badaut
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA, USA .,Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA.,CNRS UMR5287, University of Bordeaux, Bordeaux, France
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32
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Rocca A, Pignat JM, Berney L, Jöhr J, Van de Ville D, Daniel RT, Levivier M, Hirt L, Luft AR, Grouzmann E, Diserens K. Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study. BMC Neurol 2016; 16:169. [PMID: 27619015 PMCID: PMC5020460 DOI: 10.1186/s12883-016-0684-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/29/2016] [Indexed: 11/23/2022] Open
Abstract
Background Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days. Methods Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization. Results Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®. Conclusions This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions. Trial registration The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432. Date of registration: 08.03.2016. Retrospectively registered.
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Affiliation(s)
- A Rocca
- Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - J-M Pignat
- Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland
| | - L Berney
- Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland
| | - J Jöhr
- Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland
| | - D Van de Ville
- Ecole Polytechnique de Lausanne (EPFL), Lausanne, Switzerland
| | - R T Daniel
- Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - M Levivier
- Department of Clinical Neurosciences, Neurosurgery Unit, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - L Hirt
- Department of Clinical Neurosciences, Neurology Unit, University Hospital CHUV, Lausanne, Switzerland
| | - A R Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - E Grouzmann
- Biomedicine Departement, University Hospital CHUV, Lausanne, Switzerland
| | - K Diserens
- Department of Clinical Neurosciences, Acute Neurorehabilitation Unit, University Hospital CHUV, Lausanne, Switzerland
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33
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Rosafio K, Castillo X, Hirt L, Pellerin L. Cell-specific modulation of monocarboxylate transporter expression contributes to the metabolic reprograming taking place following cerebral ischemia. Neuroscience 2016; 317:108-20. [DOI: 10.1016/j.neuroscience.2015.12.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 01/23/2023]
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34
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Sokolov AA, Rossetti AO, Michel P, Benninger D, Nater B, Wider C, Hirt L, Kuntzer T, Démonet JF, Du Pasquier RA, Vingerhoets F. [Neurology]. Rev Med Suisse 2016; 12:62-66. [PMID: 26946707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In 2015, cerebral stimulation becomes increasingly established in the treatment of pharmacoresistant epilepsy. Efficacy of endovascular treatment has been demonstrated for acute ischemic stroke. Deep brain stimulation at low frequency improves dysphagia and freezing of gait in Parkinson patients. Bimagrumab seems to increase muscular volume and force in patients with inclusion body myositis. In cluster-type headache, a transcutaneous vagal nerve stimulator is efficient in stopping acute attacks and also reducing their frequency. Initial steps have been undertaken towards modulating memory by stimulation of the proximal fornix. Teriflunomide is the first oral immunomodulatory drug for which efficacy has been shown in preventing conversion from clinical isolated syndrome to multiple sclerosis.
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Rocca A, Pignat JM, Berney L, Johr J, Daniel R, Levivier M, Hirt L, Diserens K. Sympathetic Activity and Early Mobilization in Patients with Severe Brain Injuries: A Preliminary Randomized Study. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tsetsou S, Michel P, Ribi C, Hirt L, Kawasaki A, Hugli O, De Leval L, Bart PA, Waeber G, Meuli R, Raffoul W, So A, Du Pasquier R. [Giant cell arteritis: guidelines of the University Hospital of Lausanne]. Rev Med Suisse 2015; 11:411-417. [PMID: 25895220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Giant cell arteritis (GCA) is a subacute/chronic vasculitis and represents the most common form of systemic vasculitis in people over the age of 50 years. The absence of clear and specific diagnostic criteria with the highly variable clinical presentation is a diagnostic challenge requesting a multidisciplinary approach. Yet, GCA is an emergency and the treatment must be initiated very rapidly due to the risk of blindness. This article presents a review of GCA as well as the diagnostic and therapeutic institutional guidelines of the University Hospital of Lausanne.
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Papavasileiou V, Milionis H, Hirt L, Michel P. Strokes and TIAs during and after carotid artery Doppler: cause or coincidence? Ultrasound Med Biol 2015; 41:418-422. [PMID: 25542481 DOI: 10.1016/j.ultrasmedbio.2014.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to explore the prevalence of acute cerebrovascular symptoms temporally related to carotid Doppler examination (DEx), in order to increase the awareness and recording of such events and to discuss possible mechanisms. All adult patients who complained of acute onset neurologic symptoms during or shortly after a carotid DEx, between 01/2003 and 12/2011 in the University Hospital of Lausanne were prospectively collected. We identified four consecutive patients with acute onset neurologic symptoms during or shortly after a carotid DEx among approximately 13,500 patients who underwent carotid DEx in our facility during the nine-year period (0.015% of all examined carotids). Clinical data, imaging reports and CTA (CT angiography) or/and ultrasound images are presented for each patient. Ischemic cerebrovascular events during or immediately after cervical Doppler could be due to chance or to several physical factors. They should be promptly recognized by Doppler personnel and properly treated, but do not put into question the overwhelming benefits of Doppler in cerebrovascular patients.
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Affiliation(s)
- Vasileios Papavasileiou
- Department of Medicine, University of Thessaly, Larissa, Greece; Stroke Unit, Department of Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Haralampos Milionis
- Stroke Unit, Department of Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lorenz Hirt
- Stroke Unit, Department of Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Stroke Unit, Department of Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
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38
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Tsetsou S, Rossetti AO, Michel P, Hirt L, Wider C, Benninger D, Kuntzer T, Nater B, Démonet JF, Schluep M, Du Pasquier RA, Vingerhoets F. [News in neurology 2014]. Rev Med Suisse 2015; 11:91-96. [PMID: 25799659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In 2014, breastfeeding during maternal antiepileptic therapy seems to be safe for the children and can be recommended. Intravenous thrombolysis by Alteplase improves the outcome after a stroke if administered within 4.5 hours and it is also recommended in elderly population over 80 years. ProSavin genic therapy for Parkinson disease is under investigation. The Transcranial Magnetic Stimulation (TMS) has an analgesic effect in neuropathic pain as well as an antidepressant effect. Antagonists of calcitonin gene-related peptide can have a beneficial role in migraine prevention. Diagnostic biomarker panels for Alzheimer disease are under investigation. Oral teriflunomide and dimethyl fumarate (BG-12) for relapsing multiple sclerosis treatment are now available in Switzerland.
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Simona BR, Hirt L, Demkó L, Zambelli T, Vörös J, Ehrbar M, Milleret V. Density gradients at hydrogel interfaces for enhanced cell penetration. Biomater Sci 2015. [DOI: 10.1039/c4bm00416g] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Interfacial crosslinking density gradients represent a simple strategy to overcome the challenge of the limited penetration of cells seeded on the surface of hydrogels. The strategy here-presented can be used both when cells need to be seeded after hydrogel processing and to enable cell migration through hydrogel elements additively manufactured.
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Affiliation(s)
- B. R. Simona
- Laboratory of Biosensors and Bioelectronics
- Institute for Biomedical Engineering
- University and ETH Zurich
- Zurich
- Switzerland
| | - L. Hirt
- Laboratory of Biosensors and Bioelectronics
- Institute for Biomedical Engineering
- University and ETH Zurich
- Zurich
- Switzerland
| | - L. Demkó
- Laboratory of Biosensors and Bioelectronics
- Institute for Biomedical Engineering
- University and ETH Zurich
- Zurich
- Switzerland
| | - T. Zambelli
- Laboratory of Biosensors and Bioelectronics
- Institute for Biomedical Engineering
- University and ETH Zurich
- Zurich
- Switzerland
| | - J. Vörös
- Laboratory of Biosensors and Bioelectronics
- Institute for Biomedical Engineering
- University and ETH Zurich
- Zurich
- Switzerland
| | - M. Ehrbar
- Laboratory for Cell and Tissue Engineering
- Department of Obstetrics
- University Hospital Zurich
- 8091 Zurich
- Switzerland
| | - V. Milleret
- Laboratory for Cell and Tissue Engineering
- Department of Obstetrics
- University Hospital Zurich
- 8091 Zurich
- Switzerland
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Berthet C, Xin L, Buscemi L, Benakis C, Gruetter R, Hirt L, Lei H. Non-invasive diagnostic biomarkers for estimating the onset time of permanent cerebral ischemia. J Cereb Blood Flow Metab 2014; 34:1848-55. [PMID: 25182663 PMCID: PMC4269763 DOI: 10.1038/jcbfm.2014.155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/23/2014] [Accepted: 08/05/2014] [Indexed: 11/10/2022]
Abstract
The treatments for ischemic stroke can only be administered in a narrow time-window. However, the ischemia onset time is unknown in ~30% of stroke patients (wake-up strokes). The objective of this study was to determine whether MR spectra of ischemic brains might allow the precise estimation of cerebral ischemia onset time. We modeled ischemic stroke in male ICR-CD1 mice using a permanent middle cerebral artery filament occlusion model with laser Doppler control of the regional cerebral blood flow. Mice were then subjected to repeated MRS measurements of ipsilateral striatum at 14.1 T. A striking initial increase in γ-aminobutyric acid (GABA) and no increase in glutamine were observed. A steady decline was observed for taurine (Tau), N-acetyl-aspartate (NAA) and similarly for the sum of NAA+Tau+glutamate that mimicked an exponential function. The estimation of the time of onset of permanent ischemia within 6 hours in a blinded experiment with mice showed an accuracy of 33±10 minutes. A plot of GABA, Tau, and neuronal marker concentrations against the ratio of acetate/NAA allowed precise separation of mice whose ischemia onset lay within arbitrarily chosen time-windows. We conclude that (1)H-MRS has the potential to detect the clinically relevant time of onset of ischemic stroke.
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Affiliation(s)
- Carole Berthet
- Department of Clinical Neurosciences, Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijing Xin
- 1] Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland [2] Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lara Buscemi
- Department of Clinical Neurosciences, Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Corinne Benakis
- Department of Clinical Neurosciences, Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rolf Gruetter
- 1] Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland [2] Department of Radiology, University of Geneva, Geneva, Switzerland [3] Department of Radiology, University of Lausanne, Lausanne, Switzerland [4] AIT, Center for Biomedical Imaging (CIBM), Institute of the Physics of Biological Systems, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Lorenz Hirt
- Department of Clinical Neurosciences, Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hongxia Lei
- 1] Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland [2] Department of Radiology, University of Lausanne, Lausanne, Switzerland
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41
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Mirante O, Price M, Puentes W, Castillo X, Benakis C, Thevenet J, Monard D, Hirt L. Endogenous protease nexin-1 protects against cerebral ischemia. Int J Mol Sci 2013; 14:16719-31. [PMID: 23949634 PMCID: PMC3759934 DOI: 10.3390/ijms140816719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 11/16/2022] Open
Abstract
The serine protease thrombin plays a role in signalling ischemic neuronal death in the brain. Paradoxically, endogenous neuroprotective mechanisms can be triggered by preconditioning with thrombin (thrombin preconditioning, TPC), leading to tolerance to cerebral ischemia. Here we studied the role of thrombin’s endogenous potent inhibitor, protease nexin-1 (PN-1), in ischemia and in tolerance to cerebral ischemia induced by TPC. Cerebral ischemia was modelled in vitro in organotypic hippocampal slice cultures from rats or genetically engineered mice lacking PN-1 or with the reporter gene lacZ knocked into the PN-1 locus PN-1HAPN-1-lacZ/HAPN-1-lacZ (PN-1 KI) exposed to oxygen and glucose deprivation (OGD). We observed increased thrombin enzyme activity in culture homogenates 24 h after OGD. Lack of PN-1 increased neuronal death in the CA1, suggesting that endogenous PN-1 inhibits thrombin-induced neuronal damage after ischemia. OGD enhanced β-galactosidase activity, reflecting PN-1 expression, at one and 24 h, most strikingly in the stratum radiatum, a glial cell layer adjacent to the CA1 layer of ischemia sensitive neurons. TPC, 24 h before OGD, additionally increased PN-1 expression 1 h after OGD, compared to OGD alone. TPC failed to induce tolerance in cultures from PN-1−/− mice confirming PN-1 as an important TPC target. PN-1 upregulation after TPC was blocked by the c-Jun N-terminal kinase (JNK) inhibitor, L-JNKI1, known to block TPC. This work suggests that PN-1 is an endogenous neuroprotectant in cerebral ischemia and a potential target for neuroprotection.
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Affiliation(s)
- Osvaldo Mirante
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
| | - Melanie Price
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
| | - Wilfredo Puentes
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
| | - Ximena Castillo
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
| | - Corinne Benakis
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
| | - Jonathan Thevenet
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
| | - Denis Monard
- Friedrich Miescher Institute for Biomedical Research, Basel 4058, Switzerland; E-Mail:
| | - Lorenz Hirt
- Stroke Laboratory, Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Lausanne University, Lausanne 1011, Switzerland; E-Mails: (O.M.); (M.P.); (W.P.); (X.C.); (C.B.); (J.T.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +41-21-314-12-68; Fax: +41-21-314-12-90
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Déglise S, Dubuis C, Mosimann P, Saucy F, Engelberger S, Hirt L, Michel P, Corpataux JM. [Management of the carotid artery stenosis]. Rev Med Suisse 2013; 9:1305-1311. [PMID: 23875259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the western world, the carotid-artery stenosis is one of the major causes of ischemic stroke in elderly people. The principal therapeutic indication is a symptomatic stenosis > 50% in the first two weeks and the surgical approach has shown the best results. Despite inferior results to carotid endarterectomy in terms of post-operative rate of stroke and/or death, except for young patients, carotid stenting remains the best choice in patients at high surgical risk. The best medical treatment, consisting in correction of cardiovascular risk factors, statin therapy and anti-aggregation led to a drastic reduction in the annual rate of stroke associated to carotid stenosis and thus limited the surgical intervention in asymptomatic patient to men with a life expectancy of at least 5 years and a stenosis > 70%.
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Affiliation(s)
- Sébastien Déglise
- Service de Chirurgie Thoracique et Vasculaire Division de Chirurgie Vasculaire, CHUV, Lausanne.
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Fukuda AM, Hirt L, Ambadipudi K, Verkman AS, Binder DK, Obenaus A, Badaut J. Abstract TP97: Improved Long-Term Outcome after Transient Cerebral Ischemia in Aquaporin-4 Knockout Mice. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Aquaporin-4 (AQP4) is an abundant aquaporin in brain that has been hypothesized to play a central role in edema formation. Furthermore, AQP4 downregulation has been correlated with connexin 43 (Cx43) downregulation, a gap junction protein important for ion and water transport through astrocyte networks. AQP4 deletion in mice was shown to be beneficial at 24 hours after permanent occlusion of the middle cerebral artery (MCAO). However, the long-term consequences of AQP4 deletion on behavior, edema, and tissue properties after stroke have not been studied.
Objective:
Following transient MCAO, behavior, lesion volumes, blood brain barrier (BBB) integrity, neuroinflammation, and astrocyte network properties with Cx43 expressions were assessed for 14 days in wild type (WT) and AQP4
-/-
mice.
Methods:
Transient (30-min) filament MCAO was performed on AQP4
-/-
(n=5) and WT (n=8) mice on a CD1 genetic background. Behavioral outcomes were assessed by rotarod, beam balance, and foot fault tests from 1 to 14 days (d) post injury. Temporal magnetic resonance imaging (MRI) was undertaken to assess lesion volume. Mice were transcardially perfused at 15 d and the brains were extracted and frozen to perform immunohistochemical analysis for IgG, AQP4, Cx43, and glial fibrillary acidic protein (GFAP).
Results:
MRI showed significantly smaller lesion volume in AQP4
-/-
at 1, 3, 7, and 14d. AQP4
-/-
mice also had improved motor function recovery with 54% and 75% decreased number of foot-faults than WT mice respectively at 1 and 3 d; and 60% increased time spent on the rotarod compared to WT over the 14 days after stroke onset. AQP4
-/-
mice had reduced IgG extravasation and Cx43 expression but increased GFAP staining compared to WT at 14d, suggesting, respectively, less BBB disruption and modified astrocyte network properties combined with altered neuroinflammation fates.
Conclusion:
AQP4 deletion resulted in improved long-term functional recovery associated with decreased lesion volumes and improved BBB integrity. Although more work must be done, the beneficial outcomes in AQP4
-/-
may partly be due to decreased Cx43 as well, resulting in not only decreased edema formation through AQP4, but also in decreased spread of edema through the astrocyte network.
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Berthet C, Castillo X, Magistretti PJ, Hirt L. New evidence of neuroprotection by lactate after transient focal cerebral ischaemia: extended benefit after intracerebroventricular injection and efficacy of intravenous administration. Cerebrovasc Dis 2012; 34:329-35. [PMID: 23154656 DOI: 10.1159/000343657] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 09/19/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lactate protects mice against the ischaemic damage resulting from transient middle cerebral artery occlusion (MCAO) when administered intracerebroventricularly at reperfusion, yielding smaller lesion sizes and a better neurological outcome 48 h after ischaemia. We have now tested whether the beneficial effect of lactate is long-lasting and if lactate can be administered intravenously. METHODS Male ICR-CD1 mice were subjected to 15-min suture MCAO under xylazine + ketamine anaesthesia. Na L-lactate (2 µl of 100 mmol/l) or vehicle was administered intracerebroventricularly at reperfusion. The neurological deficit was evaluated using a composite deficit score based on the neurological score, the rotarod test and the beam walking test. Mice were sacrificed at 14 days. In a second set of experiments, Na L-lactate (1 µmol/g body weight) was administered intravenously into the tail vein at reperfusion. The neurological deficit and the lesion volume were measured at 48 h. RESULTS Intracerebroventricularly injected lactate induced sustained neuroprotection shown by smaller neurological deficits at 7 days (median = 0, min = 0, max = 3, n = 7 vs. median = 2, min = 1, max = 4.5, n = 5, p < 0.05) and 14 days after ischaemia (median = 0, min = 0, max = 3, n = 7 vs. median = 3, min = 0.5, max = 3, n = 7, p = 0.05). Reduced tissue damage was demonstrated by attenuated hemispheric atrophy at 14 days (1.3 ± 4.0 mm(3), n = 7 vs. 12.1 ± 3.8 mm(3), n = 5, p < 0.05) in lactate-treated animals. Systemic intravenous lactate administration was also neuroprotective and attenuated the deficit (median = 1, min = 0, max = 2.5, n = 12) compared to vehicle treatment (median = 1.5, min = 1, max = 8, n = 12, p < 0.05) as well as the lesion volume at 48 h (13.7 ± 12.2 mm(3), n = 12 vs. 29.6 ± 25.4 mm(3), n = 12, p < 0.05). CONCLUSIONS The beneficial effect of lactate is long-lasting: lactate protects the mouse brain against ischaemic damage when supplied intracerebroventricularly during reperfusion with behavioural and histological benefits persisting 2 weeks after ischaemia. Importantly, lactate also protects after systemic intravenous administration, a more suitable route of administration in a clinical emergency setting. These findings provide further steps to bring this physiological, commonly available and inexpensive neuroprotectant closer to clinical translation for stroke.
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Affiliation(s)
- Carole Berthet
- Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
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Moreira T, Michel P, Binaghi S, Hirt L. Risk factor impact on blood flow velocities and clinical outcomes of stented cervical and intracranial stenoses: preliminary observations. Clin Neurol Neurosurg 2012; 114:922-9. [DOI: 10.1016/j.clineuro.2012.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 11/07/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
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Benakis C, Vaslin A, Pasquali C, Hirt L. Neuroprotection by inhibiting the c-Jun N-terminal kinase pathway after cerebral ischemia occurs independently of interleukin-6 and keratinocyte-derived chemokine (KC/CXCL1) secretion. J Neuroinflammation 2012; 9:76. [PMID: 22533966 PMCID: PMC3416579 DOI: 10.1186/1742-2094-9-76] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 04/25/2012] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral ischemia is associated with the activation of glial cells, infiltration of leukocytes and an increase in inflammatory mediators in the ischemic brain and systemic circulation. How this inflammatory response influences lesion size and neurological outcome remains unclear. D-JNKI1, an inhibitor of the c-Jun N-terminal kinase pathway, is strongly neuroprotective in animal models of stroke. Intriguingly, the protection mediated by D-JNKI1 is high even with intravenous administration at very low doses with undetectable drug levels in the brain, pointing to a systemic mode of action, perhaps on inflammation. Findings We evaluated whether D-JNKI1, administered intravenously 3 h after the onset of middle cerebral artery occlusion (MCAO), modulates secretion of the inflammatory mediators interleukin-6 and keratinocyte-derived chemokine in the plasma and from the spleen and brain at several time points after MCAO. We found an early release of both mediators in the systemic circulation followed by an increase in the brain and went on to show a later systemic increase in vehicle-treated mice. Release of interleukin-6 and keratinocyte-derived chemokine from the spleen of mice with MCAO was not significantly different from sham mice. Interestingly, the secretion of these inflammatory mediators was not altered in the systemic circulation or brain after successful neuroprotection with D-JNKI1. Conclusions We demonstrate that neuroprotection with D-JNKI1 after experimental cerebral ischemia is independent of systemic and brain release of interleukin-6 and keratinocyte-derived chemokine. Furthermore, our findings suggest that the early systemic release of interleukin-6 and keratinocyte-derived chemokine may not necessarily predict an unfavorable outcome in this model.
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Affiliation(s)
- Corinne Benakis
- Department of Clinical Neuroscience, University Hospital of Lausanne-CHUV, BH 07 Lausanne 1011, Switzerland.
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Yiallourou TI, Odier C, Heinzer R, Hirt L, Martin BA, Stergiopulos N, Haba-Rubio J. The effect of continuous positive airway pressure on total cerebral blood flow in healthy awake volunteers. Sleep Breath 2012; 17:289-96. [PMID: 22434361 DOI: 10.1007/s11325-012-0688-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/17/2012] [Accepted: 03/05/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea. However, the physiologic impact of CPAP on cerebral blood flow (CBF) is not well established. Ultrasound can be used to estimate CBF, but there is no widespread accepted protocol. We studied the physiologic influence of CPAP on CBF using a method integrating arterial diameter and flow velocity (FV) measurements obtained for each vessel supplying blood to the brain. METHODS FV and lumen diameter of the left and right internal carotid, vertebral, and middle cerebral arteries were measured using duplex Doppler ultrasound with and without CPAP at 15 cm H(2)O, applied in a random order. Transcutaneous carbon dioxide (PtcCO(2)), heart rate (HR), blood pressure (BP), and oxygen saturation were monitored. Results were compared with a theoretical prediction of CBF change based on the effect of partial pressure of carbon dioxide on CBF. RESULTS Data were obtained from 23 healthy volunteers (mean ± SD; 12 male, age 25.1 ± 2.6 years, body mass index 21.8 ± 2.0 kg/m(2)). The mean experimental and theoretical CBF decrease under CPAP was 12.5 % (p < 0.001) and 11.9 % (p < 0.001), respectively. The difference between experimental and theoretical CBF reduction was not statistically significant (3.84 ± 79 ml/min, p = 0.40). There was a significant reduction in PtcCO(2) with CPAP (p = <0.001) and a significant increase in mean BP (p = 0.0017). No significant change was observed in SaO(2) (p = 0.21) and HR (p = 0.62). CONCLUSION Duplex Doppler ultrasound measurements of arterial diameter and FV allow for a noninvasive bedside estimation of CBF. CPAP at 15 cm H(2)O significantly decreased CBF in healthy awake volunteers. This effect appeared to be mediated predominately through the hypocapnic vasoconstriction coinciding with PCO(2) level reduction. The results suggest that CPAP should be used cautiously in patients with unstable cerebral hemodynamics.
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Alf MF, Lei H, Berthet C, Hirt L, Gruetter R, Mlynarik V. High-resolution spatial mapping of changes in the neurochemical profile after focal ischemia in mice. NMR Biomed 2012; 25:247-254. [PMID: 21766382 DOI: 10.1002/nbm.1740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 05/31/2023]
Abstract
After ischemic stroke, the ischemic damage to brain tissue evolves over time and with an uneven spatial distribution. Early irreversible changes occur in the ischemic core, whereas, in the penumbra, which receives more collateral blood flow, the damage is more mild and delayed. A better characterization of the penumbra, irreversibly damaged and healthy tissues is needed to understand the mechanisms involved in tissue death. MRSI is a powerful tool for this task if the scan time can be decreased whilst maintaining high sensitivity. Therefore, we made improvements to a (1)H MRSI protocol to study middle cerebral artery occlusion in mice. The spatial distribution of changes in the neurochemical profile was investigated, with an effective spatial resolution of 1.4 μL, applying the protocol on a 14.1-T magnet. The acquired maps included the difficult-to-separate glutamate and glutamine resonances and, to our knowledge, the first mapping of metabolites γ-aminobutyric acid and glutathione in vivo, within a metabolite measurement time of 45 min. The maps were in excellent agreement with findings from single-voxel spectroscopy and offer spatial information at a scan time acceptable for most animal models. The metabolites measured differed with respect to the temporal evolution of their concentrations and the localization of these changes. Specifically, lactate and N-acetylaspartate concentration changes largely overlapped with the T(2)-hyperintense region visualized with MRI, whereas changes in cholines and glutathione affected the entire middle cerebral artery territory. Glutamine maps showed elevated levels in the ischemic striatum until 8 h after reperfusion, and until 24 h in cortical tissue, indicating differences in excitotoxic effects and secondary energy failure in these tissue types.
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Affiliation(s)
- Malte F Alf
- Laboratory of Functional and Metabolic Imaging, Institute of the Physics of Biological System, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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49
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Chabwine JN, Rossetti AR, Hirt L, Kuntzer T, Schluep M, Michel P, Démonet JF, du Pasquier RA, Vingerhoets FG. [Neurology]. Rev Med Suisse 2012; 8:46-50. [PMID: 22303740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In 2011, new oral anticoagulants for atrial fibrillation are available and the ABCD3-I score predicting stroke after TIA updates the ABCD2 score. New McDonald criteria allow faster MS diagnosis and the first oral treatment (fingolimod) for MS can be prescribed. A new anti-antiepileptic drug (retigabine) is available and sodium valproate has long term neurological adverse effects after in utero exposure. Among Parkinson disease treatments, deep brain stimulation is extending applications and dopamine agonists with extended release are as efficient and well tolerated as standard forms at long term scale. Monoclonal antibodies and immunosuppressant agents are proposed as good alternatives in the treatment of chronic dysimmune polyneuropathies. Gene therapy for the treatment of genetic myopathies is progressing.
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Affiliation(s)
- J N Chabwine
- Service de neurologie, Département de neurosciences cliniques, CHUV, Lausanne.
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50
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Diserens K, Moreira T, Hirt L, Faouzi M, Grujic J, Bieler G, Vuadens P, Michel P. Early mobilization out of bed after ischaemic stroke reduces severe complications but not cerebral blood flow: a randomized controlled pilot trial. Clin Rehabil 2011; 26:451-9. [DOI: 10.1177/0269215511425541] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate whether early mobilization after acute ischaemic stroke is better than delayed mobilization with regard to medical complications and if it is safe in relation to neurological function and cerebral blood flow. Design: Randomized controlled pilot trial of early versus delayed mobilization out of bed with incidence of severe complications as the primary outcome. Setting: Acute stroke unit in the neurology department of a University Hospital. Participants: Fifty patients after ischaemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score >6 were recruited. Intervention: All patients were treated with physiotherapy immediately after their admission. In the early protocol patients were mobilized out of bed after 52 hours, in the delayed protocol after seven days. Results: Eight out of 50 randomized patients were excluded from the per-protocol analysis because of early transfer to other hospitals. There were 2 (8%) severe complications in the 25 early mobilization patients and 8 (47%) in the 17 delayed mobilization patients ( P < 0.006). There were no differences in the total number of complications or in clinical outcome. In the 26 patients (62%) who underwent serial transcranial Doppler ultrasonography, no blood flow differences were found. Conclusion: We found an apparent reduction in severe complications and no increase in total complications with an early mobilization protocol after acute ischaemic stroke. No influence on neurological three-month outcomes or on cerebral blood flow was seen. These results justify larger trials comparing mobilization protocols with possibly even faster mobilization out of bed than explored here.
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Affiliation(s)
- Karin Diserens
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire and University of Lausanne, Switzerland
| | - Tiago Moreira
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire and University of Lausanne, Switzerland
| | - Lorenz Hirt
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire and University of Lausanne, Switzerland
| | - Mohamed Faouzi
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Jelena Grujic
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire and University of Lausanne, Switzerland
| | - Gilles Bieler
- Medical Polyclinics, Centre Hospitalier Universitaire and University of Lausanne, Switzerland
| | | | - Patrik Michel
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire and University of Lausanne, Switzerland
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