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Ollen-Bittle N, Roseborough AD, Wang W, Wu JLD, Whitehead SN. Connecting cellular mechanisms and extracellular vesicle cargo in traumatic brain injury. Neural Regen Res 2024; 19:2119-2131. [PMID: 38488547 PMCID: PMC11034607 DOI: 10.4103/1673-5374.391329] [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: 08/17/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 04/24/2024] Open
Abstract
Traumatic brain injury is followed by a cascade of dynamic and complex events occurring at the cellular level. These events include: diffuse axonal injury, neuronal cell death, blood-brain barrier break down, glial activation and neuroinflammation, edema, ischemia, vascular injury, energy failure, and peripheral immune cell infiltration. The timing of these events post injury has been linked to injury severity and functional outcome. Extracellular vesicles are membrane bound secretory vesicles that contain markers and cargo pertaining to their cell of origin and can cross the blood-brain barrier. These qualities make extracellular vesicles intriguing candidates for a liquid biopsy into the pathophysiologic changes occurring at the cellular level post traumatic brain injury. Herein, we review the most commonly reported cargo changes in extracellular vesicles from clinical traumatic brain injury samples. We then use knowledge from animal and in vitro models to help infer what these changes may indicate regrading cellular responses post traumatic brain injury. Future research should prioritize labeling extracellular vesicles with markers for distinct cell types across a range of timepoints post traumatic brain injury.
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Affiliation(s)
- Nikita Ollen-Bittle
- Department of Anatomy and Cell Biology, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Austyn D. Roseborough
- Department of Anatomy and Cell Biology, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Wenxuan Wang
- Department of Anatomy and Cell Biology, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jeng-liang D. Wu
- Department of Anatomy and Cell Biology, Western University, London, ON, Canada
| | - Shawn N. Whitehead
- Department of Anatomy and Cell Biology, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Deparment of Clinical Neurological Sciences, Western University, London, ON, Canada
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Roseborough AD, Ollen-Bittle N, Whitehead SN. Using microglia-derived extracellular vesicles to capture diversity of microglial activation phenotypes following neurological injury. Neural Regen Res 2024; 19:1633-1634. [PMID: 38103216 PMCID: PMC10960273 DOI: 10.4103/1673-5374.389632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/14/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Austyn D. Roseborough
- Vulnerable Brain Laboratory, Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, London, OH, Canada
| | - Nikita Ollen-Bittle
- Vulnerable Brain Laboratory, Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, London, OH, Canada
| | - Shawn N. Whitehead
- Vulnerable Brain Laboratory, Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, London, OH, Canada
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Ollen-Bittle N, Pejhan S, Pasternak SH, Keene CD, Zhang Q, Whitehead SN. Co-registration of MALDI-MSI and histology demonstrates gangliosides co-localize with amyloid beta plaques in Alzheimer's disease. Res Sq 2024:rs.3.rs-3985371. [PMID: 38463949 PMCID: PMC10925476 DOI: 10.21203/rs.3.rs-3985371/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Alzheimer's disease (AD) is a progressive neurological condition characterized by impaired cognitive function and behavioural alterations. While AD research historically centered around mis-folded proteins, advances in mass spectrometry techniques have triggered increased exploration of the AD lipidome with lipid dysregulation emerging as a critical player in AD pathogenesis. Gangliosides are a class of glycosphingolipids enriched within the central nervous system. Previous work has suggested a shift in a-series gangliosides from complex (GM1) to simple (GM2 and GM3) species may be related to the development of neurodegenerative disease. Additionally, complex gangliosides with 20 carbon sphingosine chains have been shown to increase in the aging brain. In this study, we utilized matrix assisted laser desorption ionization mass spectrometry imaging (MALDI-MSI) to interrogate the in situ relationship of a-series gangliosides with either 18 or 20 carbon sphingosine chains (d18:1 or d20:1 respectively) in the post-mortem human AD brain. Here, we expanded upon previous literature and demonstrated a significant decrease in the GM1 d20:1:GM1 d18:1 ratio in regions of the dentate gyrus and entorhinal cortex in AD relative to control brain tissue. Then we demonstrated that the MALDI-MSI profile of GM3 co-localizes with histologically confirmed amyloid beta (Aβ) plaques and found a significant increase in both GM1 and GM3 in proximity to Aβ plaques. Collectively these results support past literature and demonstrate a perturbation of the ganglioside profile in AD. Moreover, this work validates a pipeline for MALDI-MSI and classic histological staining in the same tissue sections. This demonstrates feasibility for integrating untargeted mass spectrometry imaging approaches into a digital pathology framework.
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Affiliation(s)
- Nikita Ollen-Bittle
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 5C1
| | - Shervin Pejhan
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada
| | - Stephen H Pasternak
- Robarts Research Institute, Schulich School of Medicine and Dentistry, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 5C1
| | - C Dirk Keene
- Department of Laboratory Medicine & Pathology, Division of Neuropathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Qi Zhang
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON, Canada
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 5C1
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Ollen-Bittle N, Sivajohan A, Jesin J, Gasim M, Watling C. Examining the Effect of Virtual Learning on Canadian Pre-Clerkship Medical Student Well-Being During the COVID-19 Pandemic. Perspect Med Educ 2023; 12:488-496. [PMID: 37929202 PMCID: PMC10624142 DOI: 10.5334/pme.1184] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Introduction The restrictions of the COVID-19 pandemic resulted in the broad and abrupt incorporation of virtual/online learning into medical school curricula. While current literature explores the effectiveness and economic advantages of virtual curricula, robust literature surrounding the effect of virtual learning on medical student well-being is needed. This study aims to explore the effects of a predominantly virtual curriculum on pre-clerkship medical student well-being. Methods This study followed a constructivist grounded theory approach. During the 2020-2021 and 2021-2022 academic years, students in pre-clerkship medical studies at Western University in Canada were interviewed by medical student researchers over Zoom. Data was analyzed iteratively using constant comparison. Results We found that students experiencing virtual learning faced two key challenges: 1) virtual learning may be associated with an increased sense of social isolation, negatively affecting wellbeing, 2) virtual learning may impede or delay the development of trainees' professional identity. With time, however, we found that many students were able to adapt by using protective coping strategies that enabled them to appreciate positive elements of online learning, such as its flexibility. Discussion When incorporating virtual learning into medical education, curriculum developers should prioritize optimizing existing and creating new ways for students to interact with both peers and faculty to strengthen medical student identity and combat feelings of social isolation.
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Affiliation(s)
- Nikita Ollen-Bittle
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
| | - Asaanth Sivajohan
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
| | - Joshua Jesin
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
| | - Majid Gasim
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
| | - Christopher Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, CA
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Ollen-Bittle N, Lee D, Proulx A, Duggal N, Van Uum SH. The importance of measuring prolactin prior to surgical management of a pituitary lesion: An illustrative case. Radiol Case Rep 2023; 18:3889-3893. [PMID: 37670916 PMCID: PMC10475397 DOI: 10.1016/j.radcr.2023.08.047] [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: 07/16/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
The characterization of sellar and suprasellar lesions is reliant on patient presentation, medical imaging, and hormone profiling. Prolactinomas are the most common type of functional pituitary adenomas, accounting for up to 57%. Importantly, prolactinomas can present without clear symptoms and with doubtful or even normal imaging. A 41-year-old male patient was referred to neurosurgery for consideration for resection of a sellar lesion, as initial CT imaging suggested a large meningioma. Subsequent MRI of the sella favored macroadenoma, meningioma, and craniopharyngioma as the top differential considerations. These conditions all indicate a diagnosis that would require surgical management. Clinical evaluation of this patient did not elicit any obvious clinical features suggestive of hyperprolactinemia. Fortunately, we obtained a full hormone panel which revealed a significantly elevated prolactin level of 17,390 µg/L. Based on this elevated prolactin level, we diagnosed a pituitary giant prolactinoma. Treatment with a dopamine agonist therapy was initiated and the response confirmed this diagnosis. This case demonstrates the importance of obtaining a prolactin level prior to surgical management of a sellar lesion. Had a prolactin level not been obtained, this patient would have undergone surgical resection based on both the imaging and clinical judgment.
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Affiliation(s)
- Nikita Ollen-Bittle
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
- Department of Anatomy and Cell Biology, Western University, Ontario, Canada
| | - Donald Lee
- Radiology, London Health Sciences Centre, Ontario, Canada
| | - Alain Proulx
- Ophthalmology, London Health Sciences Centre, Ontario, Canada
| | - Neil Duggal
- Neurosurgery, London Health Sciences Centre, Ontario, Canada
| | - Stan H.M. Van Uum
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
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Jesin JA, Sivajohan A, Gasim M, Ollen-Bittle N, Kirpalani A. Medical Students as Educators: Addressing Teaching Skills Through a Pre-clerkship Development Group. Med Sci Educ 2023; 33:1039-1041. [PMID: 37886268 PMCID: PMC10597893 DOI: 10.1007/s40670-023-01881-1] [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] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/28/2023]
Abstract
In medicine, effective teaching is requisite for both successful patient care and trainee development. However, opportunities for medical students to gain exposure to pedagogical principles and hone teaching skills are currently limited. Our initiative provides avenues for medical students to intentionally develop their teaching skill set from an early stage.
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Affiliation(s)
- Joshua A. Jesin
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
| | - Asaanth Sivajohan
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
| | - Majid Gasim
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
| | - Nikita Ollen-Bittle
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
| | - Amrit Kirpalani
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
- Division of Paediatric Nephrology, Children’s Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
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Ollen-Bittle N, Lowry CA, Donovan KE, Andrew RD, Whitehead SN. Validating MALDI-IMS Feasibility in Ex Vivo Brain Slices. J Am Soc Mass Spectrom 2023. [PMID: 37471497 DOI: 10.1021/jasms.3c00152] [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: 07/22/2023]
Abstract
Matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI-IMS) generates unique mass spectra in X/Y coordinates across a tissue sample, thus allowing for the spatial detection and relative quantification of biologic compounds in situ. The soft ionization of MALDI-IMS makes it an ideal technique for high-resolution imaging of complex lipid species. Lipid-based spatial chemical maps derived from MALDI-IMS provide critical insight into the unique molecular profiles of a variety of neurologic diseases. Ex vivo brain slice preparations are a prominent alternative to in vivo animal models for studying many different neurologic conditions. For the first time, we present a feasible protocol for achieving reproducible lipidomic MALDI-IMS data from ex vivo rat brain slices and provide evidence that ex vivo brain slices maintain spatiochemical lipidomic profiles representative of an intact whole brain. We conducted a methods comparison assessing the lipid profiles within the neocortex, striatum, and corpus callosum between coronal sections taken from ex vivo brain slices and the current gold standard tissue preparation method, fresh frozen whole brains. For the first time we demonstrate a technique by which 400 μm ex vivo brain slices can be extracted from an imaging chamber and prepared for MALDI-IMS in a way that preserves their lipidomic integrity. We demonstrate the feasibility of MALDI-IMS in ex vivo brain slices and provide a roadmap for MALDI-IMS utilization in uncharted neuroscience fields.
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Affiliation(s)
- Nikita Ollen-Bittle
- Department of Anatomy and Cell Biology, Western University, London, Ontario N6A 5C1, Canada
| | - Chloe A Lowry
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Katherine E Donovan
- Department of Chemistry, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R David Andrew
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Shawn N Whitehead
- Department of Anatomy and Cell Biology, Western University, London, Ontario N6A 5C1, Canada
- Deparment of Clinical Neurological Sciences, Western University, London, Ontario N6A 5C1, Canada
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Andrew RD, Farkas E, Hartings JA, Brennan KC, Herreras O, Müller M, Kirov SA, Ayata C, Ollen-Bittle N, Reiffurth C, Revah O, Robertson RM, Dawson-Scully KD, Ullah G, Dreier JP. Questioning Glutamate Excitotoxicity in Acute Brain Damage: The Importance of Spreading Depolarization. Neurocrit Care 2022; 37:11-30. [PMID: 35194729 PMCID: PMC9259542 DOI: 10.1007/s12028-021-01429-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Within 2 min of severe ischemia, spreading depolarization (SD) propagates like a wave through compromised gray matter of the higher brain. More SDs arise over hours in adjacent tissue, expanding the neuronal damage. This period represents a therapeutic window to inhibit SD and so reduce impending tissue injury. Yet most neuroscientists assume that the course of early brain injury can be explained by glutamate excitotoxicity, the concept that immediate glutamate release promotes early and downstream brain injury. There are many problems with glutamate release being the unseen culprit, the most practical being that the concept has yielded zero therapeutics over the past 30 years. But the basic science is also flawed, arising from dubious foundational observations beginning in the 1950s METHODS: Literature pertaining to excitotoxicity and to SD over the past 60 years is critiqued. RESULTS Excitotoxicity theory centers on the immediate and excessive release of glutamate with resulting neuronal hyperexcitation. This instigates poststroke cascades with subsequent secondary neuronal injury. By contrast, SD theory argues that although SD evokes some brief glutamate release, acute neuronal damage and the subsequent cascade of injury to neurons are elicited by the metabolic stress of SD, not by excessive glutamate release. The challenge we present here is to find new clinical targets based on more informed basic science. This is motivated by the continuing failure by neuroscientists and by industry to develop drugs that can reduce brain injury following ischemic stroke, traumatic brain injury, or sudden cardiac arrest. One important step is to recognize that SD plays a central role in promoting early neuronal damage. We argue that uncovering the molecular biology of SD initiation and propagation is essential because ischemic neurons are usually not acutely injured unless SD propagates through them. The role of glutamate excitotoxicity theory and how it has shaped SD research is then addressed, followed by a critique of its fading relevance to the study of brain injury. CONCLUSIONS Spreading depolarizations better account for the acute neuronal injury arising from brain ischemia than does the early and excessive release of glutamate.
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Affiliation(s)
| | - Eszter Farkas
- Hungarian Centre of Excellence for Molecular Medicine-University of Szeged, Cerebral Blood Flow and Metabolism Research Group, Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | | | | | | | | | | | - Cenk Ayata
- Harvard Medical School, Harvard University, Boston, MA USA
| | | | - Clemens Reiffurth
- Center for Stroke Research Berlin, Berlin, Germany ,Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Omer Revah
- School of Medicine, Stanford University, Stanford, CA USA
| | | | | | | | - Jens P. Dreier
- Center for Stroke Research Berlin, Berlin, Germany ,Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany ,Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany ,Department of Neurology, Corporate Member of Freie Universität Berlin, Berlin, Germany ,Department of Neurology, Humboldt-Universität zu Berlin, Berlin, Germany ,Department of Neurology, Berlin Institute of Health, Berlin, Germany ,Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany ,Einstein Center for Neurosciences Berlin, Berlin, Germany
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Andrew RD, Hartings JA, Ayata C, Brennan KC, Dawson-Scully KD, Farkas E, Herreras O, Kirov SA, Müller M, Ollen-Bittle N, Reiffurth C, Revah O, Robertson RM, Shuttleworth CW, Ullah G, Dreier JP. The Critical Role of Spreading Depolarizations in Early Brain Injury: Consensus and Contention. Neurocrit Care 2022; 37:83-101. [PMID: 35257321 PMCID: PMC9259543 DOI: 10.1007/s12028-021-01431-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 04/20/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND When a patient arrives in the emergency department following a stroke, a traumatic brain injury, or sudden cardiac arrest, there is no therapeutic drug available to help protect their jeopardized neurons. One crucial reason is that we have not identified the molecular mechanisms leading to electrical failure, neuronal swelling, and blood vessel constriction in newly injured gray matter. All three result from a process termed spreading depolarization (SD). Because we only partially understand SD, we lack molecular targets and biomarkers to help neurons survive after losing their blood flow and then undergoing recurrent SD. METHODS In this review, we introduce SD as a single or recurring event, generated in gray matter following lost blood flow, which compromises the Na+/K+ pump. Electrical recovery from each SD event requires so much energy that neurons often die over minutes and hours following initial injury, independent of extracellular glutamate. RESULTS We discuss how SD has been investigated with various pitfalls in numerous experimental preparations, how overtaxing the Na+/K+ ATPase elicits SD. Elevated K+ or glutamate are unlikely natural activators of SD. We then turn to the properties of SD itself, focusing on its initiation and propagation as well as on computer modeling. CONCLUSIONS Finally, we summarize points of consensus and contention among the authors as well as where SD research may be heading. In an accompanying review, we critique the role of the glutamate excitotoxicity theory, how it has shaped SD research, and its questionable importance to the study of early brain injury as compared with SD theory.
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Affiliation(s)
- R. David Andrew
- grid.410356.50000 0004 1936 8331Queen’s University, Kingston, ON Canada
| | - Jed A. Hartings
- grid.24827.3b0000 0001 2179 9593University of Cincinnati, Cincinnati, OH USA
| | - Cenk Ayata
- grid.38142.3c000000041936754XHarvard Medical School, Harvard University, Boston, MA USA
| | - K. C. Brennan
- grid.223827.e0000 0001 2193 0096The University of Utah, Salt Lake City, UT USA
| | | | - Eszter Farkas
- grid.9008.10000 0001 1016 96251HCEMM-USZ Cerebral Blood Flow and Metabolism Research Group, and the Department of Cell Biology and Molecular Medicine, Faculty of Science and Informatics & Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Oscar Herreras
- grid.419043.b0000 0001 2177 5516Instituto de Neurobiologia Ramon Y Cajal (Consejo Superior de Investigaciones Científicas), Madrid, Spain
| | - Sergei. A. Kirov
- grid.410427.40000 0001 2284 9329Medical College of Georgia, Augusta, GA USA
| | - Michael Müller
- grid.411984.10000 0001 0482 5331University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Nikita Ollen-Bittle
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, ON Canada
| | - Clemens Reiffurth
- grid.7468.d0000 0001 2248 7639Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and the Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health., Berlin, Germany
| | - Omer Revah
- grid.168010.e0000000419368956School of Medicine, Stanford University, Stanford, CA USA
| | | | | | - Ghanim Ullah
- grid.170693.a0000 0001 2353 285XUniversity of South Florida, Tampa, FL USA
| | - Jens P. Dreier
- grid.7468.d0000 0001 2248 7639Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and the Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health., Berlin, Germany
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