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Ota S, Kotani T, Matsuda S, Nishioka D, Masuda Y, Unoda K, Hosokawa T, Ishida S, Takeuchi T. Initial serum GM-CSF levels are associated with the severity of cerebral small vessel disease in microscopic polyangiitis patients. J Neuroimmunol 2021; 359:577671. [PMID: 34371207 DOI: 10.1016/j.jneuroim.2021.577671] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022]
Abstract
Serum cytokine levels were comprehensively measured, and the association with cerebrovascular lesions on brain magnetic resonance imaging (MRI) in microscopic polyangiitis (MPA) patients was investigated. The initial serum granulocyte-macrophage colony-stimulating factor (GM-CSF) levels were significantly higher in the high-grade white matter hyperintensities (WMH) group than those in the low-grade WMH group. In multivariate analyses, high serum levels of GM-CSF were independently associated with high-grade WMH. The initial serum GM-CSF levels correlated positively with the Birmingham Vasculitis Activity Score and semi-quantitative scales of WMH. The initial serum GM-CSF levels were associated with the severity of WMH in MPA patients.
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Affiliation(s)
- Shin Ota
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Takuya Kotani
- Division of Rheumatology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
| | - Shogo Matsuda
- Division of Rheumatology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Daisuke Nishioka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan
| | - Yuichi Masuda
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Kiichi Unoda
- Department of Internal Medicine, Osaka Medical College Mishima-Minami Hospital, Takatsuki, Osaka 569-8686, Japan
| | - Takafumi Hosokawa
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Shimon Ishida
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
| | - Tohru Takeuchi
- Division of Rheumatology, Department of Internal Medicine IV, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
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Hannawi Y, Yanek LR, Kral BG, Becker LC, Vaidya D, Haughey NJ, Becker DM, Nyquist PA. White Matter Injury Is Associated with Reduced Manual Dexterity and Elevated Serum Ceramides in Subjects with Cerebral Small Vessel Disease. Cerebrovasc Dis 2020; 50:100-107. [PMID: 33279889 PMCID: PMC7878290 DOI: 10.1159/000511937] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We have demonstrated that asymptomatic cerebral small vessel disease (cSVD) measured by white matter hyperintensity volume is associated with reduced manipulative manual dexterity on the Grooved Peg Board Test (GPBT) in middle-aged healthy individuals with a family history of early coronary artery disease. In this current study, we aim to identify the association of subcortical white matter microstructural impairment measured by diffusion tensor imaging, manual dexterity measured by GPBT and circulating serums ceramide, another marker for white matter injury. We hypothesize that lower regional fractional anisotropy (rFA) is associated with worse performance on GPBT and elevated serum ceramides in the same study population. METHODS rFA of 48 regions representing the subcortical white matters were analyzed in GeneSTAR participants in addition to serum ceramides and GPBT scores. Unadjusted univariable analyses with Bonferroni correction for multiple comparisons were completed using Spearman correlation for testing the associations between ceramides, rFA of subcortical white matter, and GPBT performance. Subsequently, sensitivity analyses were performed after excluding the participants that had any physical limitation that may influence their performance on GPBT. Finally, in the adjusted analysis using generalized estimating equation, linear regression models were performed for the areas that met significance threshold in the unadjusted analyses. RESULTS 112 subjects (age [49 ± 11], 51% female, 39.3% African American) were included. Adjusted analyses for the significant correlations that met the Bonferroni correction threshold in the unadjusted univariable analyses identified significant negative associations between rFA of the right fornix (RF) and log-GPBT score (β = -0.497, p = 0.037). In addition, rFA of RF negatively correlated with log serum ceramide levels (C18: β = -0.03, p = 0.003, C20: β = -0.0002, p = 0.004) and rFA of left genu of corpus callosum negatively correlated with log C18 level (β = -0.0103, p = 0.027). CONCLUSIONS These results demonstrate that subcortical microstructural white matter disruption is associated with elevated serum ceramides and reduced manual dexterity in a population with cSVD. These findings suggest that injury to white matter tracts undermines neural networks, with functional consequences in a middle-aged population with cardiovascular risk factors.
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Affiliation(s)
- Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, Ohio, USA
| | - Lisa R Yanek
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian G Kral
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lewis C Becker
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dhananjay Vaidya
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Norman J Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Diane M Becker
- GeneSTAR Research Program, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Nyquist
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology and Critical Care Medicine, Neurosurgery, Johns Hopkins University, University School of Medicine, Baltimore, Maryland, USA,
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You Q, Peng Q, Yu Z, Jin H, Zhang J, Sun W, Huang Y. Plasma lipidomic analysis of sphingolipids in patients with large artery atherosclerosis cerebrovascular disease and cerebral small vessel disease. Biosci Rep 2020; 40:BSR20201519. [PMID: 32830858 PMCID: PMC7502657 DOI: 10.1042/bsr20201519] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sphingolipids mainly consist of ceramides (Cer), sphingomyelins (SM) and glycosphingolipids. Sphingolipids are related with coronary heart disease and metabolic disease, but there're few studies about cerebrovascular disease. The purpose was to detect sphingolipids in plasma of patients with large artery atherosclerosis (LAA) cerebrovascular disease and cerebral small vessel disease (CSVD) to explore the similarities and differences of pathogenesis of the two subtypes. METHODS 20 patients with LAA cerebrovascular disease, 20 patients with age-related CSVD, 10 patients with Fabry disease and 14 controls were enrolled from October 2017 to January 2019. Ultra-high performance liquid chromatography-quadruple-time-of-flight mass spectrometry/mass spectrometry was used to determine sphingolipids. Univariate combined with multivariate analysis was used for comparison. Receiver operating characteristic curves were used to determine sensitivities and specificities. RESULTS 276 sphingolipids were detected, including 39 Cer, 3 ceramide phosphates, 72 glycosphingolipids and 162 SM. (1) Cer (d36:3), Cer (d34:2), Cer (d38:6), Cer (d36:4) and Cer (d16:0/18:1) were increased in LAA; SM (d34:1), Cer (d34:2), Cer (d36:4), Cer (d16:0/18:1), Cer (d38:6), Cer (d36:3) and Cer (d32:0) were increased in age-related CSVD. (2) Cer (d36:4) and SM (d34:1) were increased in age-related CSVD compared with LAA. (3) Total trihexosyl ceramides were increased in Fabry group compared with control (P<0.05); SM (d34:1) was increased in Fabry group. CONCLUSIONS Ceramides are increased in both LAA and age-related CSVD, which may be related to similar risk factors and pathophysiological process of arteriosclerosis; SM is increased in both age-related CSVD and Fabry disease, suggesting that increased SM may be associated with CSVD. Glycosphingolipids, trihexosylceramides in particular, are increased in Fabry disease.
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Affiliation(s)
- Qian You
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
| | - Qing Peng
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
| | - Zemou Yu
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
| | - Jing Zhang
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital 100034, Beijing, China
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Gatti L, Tinelli F, Scelzo E, Arioli F, Di Fede G, Obici L, Pantoni L, Giaccone G, Caroppo P, Parati EA, Bersano A. Understanding the Pathophysiology of Cerebral Amyloid Angiopathy. Int J Mol Sci 2020; 21:ijms21103435. [PMID: 32414028 PMCID: PMC7279405 DOI: 10.3390/ijms21103435] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA), one of the main types of cerebral small vessel disease, is a major cause of spontaneous intracerebral haemorrhage and an important contributor to cognitive decline in elderly patients. Despite the number of experimental in vitro studies and animal models, the pathophysiology of CAA is still largely unknown. Although several pathogenic mechanisms including an unbalance between production and clearance of amyloid beta (Aβ) protein as well as ‘the prion hypothesis’ have been invoked as possible disease triggers, they do not explain completely the disease pathogenesis. This incomplete disease knowledge limits the implementation of treatments able to prevent or halt the clinical progression. The continuous increase of CAA patients makes imperative the development of suitable experimental in vitro or animal models to identify disease biomarkers and new pharmacological treatments that could be administered in the early disease stages to prevent irreversible changes and disease progression.
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Affiliation(s)
- Laura Gatti
- Neurobiology Laboratory, Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (L.G.); (F.T.); (F.A.)
| | - Francesca Tinelli
- Neurobiology Laboratory, Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (L.G.); (F.T.); (F.A.)
| | - Emma Scelzo
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.S.); (E.A.P.)
| | - Francesco Arioli
- Neurobiology Laboratory, Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (L.G.); (F.T.); (F.A.)
| | - Giuseppe Di Fede
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (G.D.F.); (G.G.); (P.C.)
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Leonardo Pantoni
- “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Giorgio Giaccone
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (G.D.F.); (G.G.); (P.C.)
| | - Paola Caroppo
- Unit of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (G.D.F.); (G.G.); (P.C.)
| | - Eugenio Agostino Parati
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.S.); (E.A.P.)
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.S.); (E.A.P.)
- Correspondence: ; Tel.: +39-0223943310
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Abner EL, Elahi FM, Jicha GA, Mustapic M, Al-Janabi O, Kramer JH, Kapogiannis D, Goetzl EJ. Endothelial-derived plasma exosome proteins in Alzheimer's disease angiopathy. FASEB J 2020; 34:5967-5974. [PMID: 32157747 PMCID: PMC7233139 DOI: 10.1096/fj.202000034r] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/06/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/30/2022]
Abstract
Small cerebral vascular disease (SCeVD) demonstrated by white matter hyperintensity (WMH) on MRI contributes to the development of dementia in Alzheimer's disease (AD), but it has not been possible to correlate onset, severity, or protein components of SCeVD with characteristics of WMH in living patients. Plasma endothelial-derived exosomes (EDEs) were enriched by two-step immunoabsorption from four groups of participants with no clinical evidence of cerebrovascular disease: cognitively normal (CN) without WMH (CN without SCeVD, n = 20), CN with SCeVD (n = 22), preclinical AD (pAD) + mild cognitive impairment (MCI) without SCeVD (pAD/MCI without SCeVD, n = 22), and pAD/MCI with SCeVD (n = 16) for ELISA quantification of cargo proteins. Exosome marker CD81-normalized EDE levels of the cerebrovascular-selective biomarkers large neutral amino acid transporter 1 (LAT-1), glucose transporter type 1 (Glut-1), and permeability-glycoprotein (p-GP, ABCB1) were similarly significantly higher in the CN with SCeVD and pAD/MCI with SCeVD groups than their corresponding control groups without SCeVD. CD81-normalized EDE levels of Aβ40 and Aβ42 were significantly higher in the pAD/MCI with SCeVD group but not in the CN with SCeVD group relative to controls without SCeVD. Levels of normal cellular prion protein (PrPc), a receptor for amyloid peptides, and phospho-181T-tau were higher in both CN and pAD/MCI with SCeVD groups than in the corresponding controls. High EDE levels of Aβ40, Aβ42, and phospho-181T-tau in patients with WMH suggesting SCeVD appear at the pre-clinical or MCI stage of AD and therapeutic lowering of neurotoxic peptide levels may delay progression of AD angiopathy.
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Affiliation(s)
- Erin L. Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Fanny M. Elahi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Maja Mustapic
- Cellular and Molecular Neurosciences Section, Laboratory of Neurosciences, National Institute on Aging, Baltimore, MD, USA
| | - Omar Al-Janabi
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Dimitrios Kapogiannis
- Cellular and Molecular Neurosciences Section, Laboratory of Neurosciences, National Institute on Aging, Baltimore, MD, USA
| | - Edward J. Goetzl
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Campus for Jewish Living, San Francisco, CA, USA
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Altendahl M, Maillard P, Harvey D, Cotter D, Walters S, Wolf A, Singh B, Kakarla V, Azizkhanian I, Sheth SA, Xiao G, Fox E, You M, Leng M, Elashoff D, Kramer JH, Decarli C, Elahi F, Hinman JD. An IL-18-centered inflammatory network as a biomarker for cerebral white matter injury. PLoS One 2020; 15:e0227835. [PMID: 31978079 PMCID: PMC6980497 DOI: 10.1371/journal.pone.0227835] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic systemic sterile inflammation is implicated in the pathogenesis of cerebrovascular disease and white matter injury. Non-invasive blood markers for risk stratification and dissection of inflammatory molecular substrates in vivo are lacking. We sought to identify whether an interconnected network of inflammatory biomarkers centered on IL-18 and all previously associated with white matter lesions could detect overt and antecedent white matter changes in two populations at risk for cerebral small vessel disease. In a cohort of 167 older adults (mean age: 76, SD 7.1, 83 females) that completed a cognitive battery, physical examination, and blood draw in parallel with MR imaging including DTI, we measured cerebral white matter hyperintensities (WMH) and free water (FW). Concurrently, serum levels of a biologic network of inflammation molecules including MPO, GDF-15, RAGE, ST2, IL-18, and MCP-1 were measured. The ability of a log-transformed population mean-adjusted inflammatory composite score (ICS) to associate with MR variables was demonstrated in an age and total intracranial volume adjusted model. In this cohort, ICS was significantly associated with WMH (β = 0.222, p = 0.013), FW (β = 0.3, p = 0.01), and with the number of vascular risk factor diagnoses (r = 0.36, p<0.001). In a second cohort of 131 subjects presenting for the evaluation of acute neurologic deficits concerning for stroke, we used serum levels of 11 inflammatory biomarkers in an unbiased principal component analysis which identified a single factor significantly associated with WMH. This single factor was strongly correlated with the six component ICS identified in the first cohort and was associated with WMH in a generalized linear regression model adjusted for age and gender (p = 0.027) but not acute stroke. A network of inflammatory molecules driven by IL-18 is associated with overt and antecedent white matter injury resulting from cerebrovascular disease and may be a promising peripheral biomarker for vascular white matter injury.
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Affiliation(s)
- Marie Altendahl
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Pauline Maillard
- Department of Neurology and Center for Neurosciences, University of California, Davis, CA, United States of America
| | - Danielle Harvey
- Department of Public Health Sciences, University of California, Davis, CA, United States of America
| | - Devyn Cotter
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Samantha Walters
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Amy Wolf
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Baljeet Singh
- Department of Neurology and Center for Neurosciences, University of California, Davis, CA, United States of America
| | - Visesha Kakarla
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Ida Azizkhanian
- School of Medicine, New York Medical College, Vahalla, NY, United States of America
| | - Sunil A. Sheth
- University of Texas Health McGovern School of Medicine, Department of Neurology, Houston, TX, United States of America
| | - Guanxi Xiao
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Emily Fox
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Michelle You
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Mei Leng
- Department of Medicine Statistics Core, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - David Elashoff
- Department of Medicine Statistics Core, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Joel H. Kramer
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States of America
| | - Charlie Decarli
- Department of Neurology and Center for Neurosciences, University of California, Davis, CA, United States of America
| | - Fanny Elahi
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Jason D. Hinman
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
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Woo HG, Chang Y, Ryu DR, Song TJ. Plasma Klotho concentration is associated with the presence, burden and progression of cerebral small vessel disease in patients with acute ischaemic stroke. PLoS One 2019; 14:e0220796. [PMID: 31398214 PMCID: PMC6688787 DOI: 10.1371/journal.pone.0220796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/23/2019] [Indexed: 12/26/2022] Open
Abstract
Klotho is a soluble or membrane-bound anti-aging protein, whose protective actions are important for a prudential function of many organs. Because Klotho and cerebral small vessel disease (SVD) are associated with ageing process and endothelial dysfunction, it is possible that Klotho has an association with cerebral SVD. We aimed to investigate the association of plasma Klotho concentration with the presence, burden and progression of cerebral SVD. We prospectively enrolled 262 patients with first-ever acute cerebral infarction, performed brain MRI and collected their blood samples within 24 hours of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. We estimated the total SVD score of each patient after determining the presence and burden of high-grade white matter hyperintensities (HWMHs), cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs) and asymptomatic lacunar infarctions (ALIs). Univariate and multivariate analyses were conducted to investigate association of Klotho with cerebral SVD and the total SVD score. Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean ± standard deviation of plasma Klotho concentration was 329.8 ± 194.1 pg/mL. In multivariate analysis, plasma Klotho concentration was negatively associated with the presence of HWMHs [Odds ratio (OR): 0.13, p = 0.047], HPVSs (OR: 0.22, p = 0.024) and ALIs (OR: 0.53, p = 0.021) but not associated with the presence of CMBs (OR: 0.39, p = 0.404). Plasma Klotho concentration was also negatively related to the total SVD score (unstandardized coefficients beta: −0.895, standard error = 0.317, p = 0.005, R2 = 0.239). Furthermore, plasma Klotho concentration was negatively related to the presence (OR: 0.75, 95% CI: 0.59–0.96, p = 0.025) and severity of cerebral SVD progression (OR: 0.72, 95% CI: 0.56–0.92, p = 0.009). In conclusion, plasma Klotho concentration was negatively associated with the presence, burden and progression of cerebral SVD.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Nephrology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- * E-mail:
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Atwi S, Shao H, Crane DE, da Costa L, Aviv RI, Mikulis DJ, Black SE, MacIntosh BJ. BOLD-based cerebrovascular reactivity vascular transfer function isolates amplitude and timing responses to better characterize cerebral small vessel disease. NMR Biomed 2019; 32:e4064. [PMID: 30693582 DOI: 10.1002/nbm.4064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Cerebrovascular reactivity (CVR) is a dynamic measure of the cerebral blood vessel response to vasoactive stimulus. Conventional CVR measures amplitude changes in the blood-oxygenation-level-dependent (BOLD) signal per unit change in end-tidal CO2 (PET CO2 ), effectively discarding potential timing information. This study proposes a deconvolution procedure to characterize CVR responses based on a vascular transfer function (VTF) that separates amplitude and timing CVR effects. We implemented the CVR-VTF to primarily evaluate normal-appearing white matter (WM) responses in those with a range of small vessel disease. Comparisons between simulations of PET CO2 input models revealed that boxcar and ramp hypercapnia paradigms had the lowest relative deconvolution error. We used a T2 * BOLD-MRI sequence on a 3 T MRI scanner, with a boxcar delivery model of CO2 , to test the CVR-VTF approach in 18 healthy adults and three white matter hyperintensity (WMH) groups: 20 adults with moderate WMH, 12 adults with severe WMH, and 10 adults with genetic WMH (CADASIL). A subset of participants performed a second CVR session at a one-year follow-up. Conventional CVR, area under the curve of VTF (VTF-AUC), and VTF time-to-peak (VTF-TTP) were assessed in WM and grey matter (GM) at baseline and one-year follow-up. WMH groups had lower WM VTF-AUC compared with the healthy group (p < 0.0001), whereas GM CVR did not differ between groups (p > 0.1). WM VTF-TTP of the healthy group was less than that in the moderate WMH group (p = 0.016). Baseline VTF-AUC was lower than follow-up VTF-AUC in WM (p = 0.013) and GM (p = 0.026). The intraclass correlation for VTF-AUC in WM was 0.39 and coefficient of repeatability was 0.08 [%BOLD/mm Hg]. This study assessed CVR timing and amplitude information without applying model assumptions to the CVR response; this approach may be useful in the development of robust clinical biomarkers of CSVD.
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Affiliation(s)
- Sarah Atwi
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Han Shao
- Division of Engineering Science, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - David E Crane
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Leodante da Costa
- Division of Neurosurgery, Department of Surgery, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Richard I Aviv
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David J Mikulis
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
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9
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Arba F, Piccardi B, Palumbo V, Giusti B, Nencini P, Gori AM, Sereni A, Nesi M, Pracucci G, Bono G, Bovi P, Fainardi E, Consoli D, Nucera A, Massaro F, Orlandi G, Perini F, Tassi R, Sessa M, Toni D, Abbate R, Inzitari D. Small Vessel Disease Is Associated with Tissue Inhibitor of Matrix Metalloproteinase-4 After Ischaemic Stroke. Transl Stroke Res 2019; 10:44-51. [PMID: 29687301 DOI: 10.1007/s12975-018-0627-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
Small vessel disease (SVD) is frequent in aging and stroke patients. Inflammation and remodeling of extracellular matrix have been suggested as concurrent mechanisms of SVD. We investigated the relationship between imaging features of SVD and circulating metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in patients with ischaemic stroke. In patients treated with intravenous thrombolysis, we took blood samples before intravenous thrombolysis and 90 days after the acute stroke and analysed levels of MMPs and TIMPs. We assessed leukoaraiosis, number of lacunes and brain atrophy on pre-treatment CT scan and graded global SVD burden combining such features. We investigated associations between single features, global SVD and MMPs and TIMPs at baseline and at follow-up, retaining univariate statistically significant associations in multivariate linear regression analysis and adjusting for clinical confounders. A total of 255 patients [mean (±SD) = 68.6 (± 12.7) years, 154 (59%) males] were included, 107 (42%) had no signs of SVD; 47 (19%) had from moderate to severe SVD burden. A total of 107 (42%) patients had no signs of SVD; 47 (19%) had from moderate to severe SVD burden. After adjustment, only TIMP-4 proved associations with SVD features. Brain atrophy was associated with baseline TIMP-4 (β = 0.20;p = 0.019) and leukoaraiosis with 90 days TIMP-4 (β = 0.19; p = 0.013). Global SVD score was not associated with baseline TIMP-4 levels (β = 0.10; p = 0.072), whereas was associated with 90 days TIMP-4 levels (β = 0.21; p = 0.003). Total SVD burden was associated with higher TIMP-4 levels 90 days after stroke, whereas was not during the acute phase. Our results support a biological relationship between SVD grade and TIMP-4.
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Affiliation(s)
- Francesco Arba
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy.
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Benedetta Piccardi
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Vanessa Palumbo
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Patrizia Nencini
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Alice Sereni
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, AOU Careggi, University of Florence, Florence, Italy
| | - Mascia Nesi
- Stroke Unit and Neurology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Giorgio Bono
- Stroke Unit, Department of Neurology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Paolo Bovi
- SSO Stroke Unit, Department of Neurosciences, Azienda Ospedaliera Integrata, Verona, Italy
| | - Enrico Fainardi
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | | | - Antonia Nucera
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | | | - Giovanni Orlandi
- Department of Neurosciences, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Francesco Perini
- UOC di Neurologia e Stroke Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Rossana Tassi
- U.O.C. Stroke Unit, Dipartimento di Scienze Neurologiche e Neurosensoriali, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Sessa
- U.O. Neurologia, DAI Neuroscienze-Riabilitazione, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy
| | - Rosanna Abbate
- Centro Studi Medicina Avanzata (CESMAV), Florence, Italy
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
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Hindy G, Engström G, Larsson SC, Traylor M, Markus HS, Melander O, Orho-Melander M. Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes: A Mendelian Randomization Study. Stroke 2018; 49:820-827. [PMID: 29535274 PMCID: PMC5895121 DOI: 10.1161/strokeaha.117.019653] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/19/2018] [Accepted: 02/15/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Statin therapy is associated with a lower risk of ischemic stroke supporting a causal role of low-density lipoprotein (LDL) cholesterol. However, more evidence is needed to answer the question whether LDL cholesterol plays a causal role in ischemic stroke subtypes. In addition, it is unknown whether high-density lipoprotein cholesterol and triglycerides have a causal relationship to ischemic stroke and its subtypes. Our aim was to investigate the causal role of LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides in ischemic stroke and its subtypes through Mendelian randomization (MR). METHODS Summary data on 185 genome-wide lipids-associated single nucleotide polymorphisms were obtained from the Global Lipids Genetics Consortium and the Stroke Genetics Network for their association with ischemic stroke (n=16 851 cases and 32 473 controls) and its subtypes, including large artery atherosclerosis (n=2410), small artery occlusion (n=3186), and cardioembolic (n=3427) stroke. Inverse-variance-weighted MR was used to obtain the causal estimates. Inverse-variance-weighted multivariable MR, MR-Egger, and sensitivity exclusion of pleiotropic single nucleotide polymorphisms after Steiger filtering and MR-Pleiotropy Residual Sum and Outlier test were used to adjust for pleiotropic bias. RESULTS A 1-SD genetically elevated LDL cholesterol was associated with an increased risk of ischemic stroke (odds ratio: 1.12; 95% confidence interval: 1.04-1.20) and large artery atherosclerosis stroke (odds ratio: 1.28; 95% confidence interval: 1.10-1.49) but not with small artery occlusion or cardioembolic stroke in multivariable MR. A 1-SD genetically elevated high-density lipoprotein cholesterol was associated with a decreased risk of small artery occlusion stroke (odds ratio: 0.79; 95% confidence interval: 0.67-0.90) in multivariable MR. MR-Egger indicated no pleiotropic bias, and results did not markedly change after sensitivity exclusion of pleiotropic single nucleotide polymorphisms. Genetically elevated triglycerides did not associate with ischemic stroke or its subtypes. CONCLUSIONS LDL cholesterol lowering is likely to prevent large artery atherosclerosis but may not prevent small artery occlusion nor cardioembolic strokes. High-density lipoprotein cholesterol elevation may lead to benefits in small artery disease prevention. Finally, triglyceride lowering may not yield benefits in ischemic stroke and its subtypes.
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Affiliation(s)
- George Hindy
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.).
| | - Gunnar Engström
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Susanna C Larsson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Matthew Traylor
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Hugh S Markus
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Olle Melander
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Marju Orho-Melander
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
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11
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van Leijsen EMC, Kuiperij HB, Kersten I, Bergkamp MI, van Uden IWM, Vanderstichele H, Stoops E, Claassen JAHR, van Dijk EJ, de Leeuw FE, Verbeek MM. Plasma Aβ (Amyloid-β) Levels and Severity and Progression of Small Vessel Disease. Stroke 2018. [PMID: 29540613 DOI: 10.1161/strokeaha.117.019810] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (SVD) is a frequent pathology in aging and contributor to the development of dementia. Plasma Aβ (amyloid β) levels may be useful as early biomarker, but the role of plasma Aβ in SVD remains to be elucidated. We investigated the association of plasma Aβ levels with severity and progression of SVD markers. METHODS We studied 487 participants from the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort) of whom 258 participants underwent 3 MRI assessments during 9 years. We determined baseline plasma Aβ38, Aβ40, and Aβ42 levels using ELISAs. We longitudinally assessed volume of white matter hyperintensities semiautomatically and manually rated lacunes and microbleeds. We analyzed associations between plasma Aβ and SVD markers by ANCOVA adjusted for age, sex, and hypertension. RESULTS Cross-sectionally, plasma Aβ40 levels were elevated in participants with microbleeds (mean, 205.4 versus 186.4 pg/mL; P<0.01) and lacunes (mean, 194.8 versus 181.2 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with severe white matter hyperintensities (Aβ38, 25.3 versus 22.7 pg/mL; P<0.01; Aβ40, 201.8 versus 183.3 pg/mL; P<0.05). Longitudinally, plasma Aβ40 levels were elevated in participants with white matter hyperintensity progression (mean, 194.6 versus 182.9 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with incident lacunes (Aβ38, 24.5 versus 22.5 pg/mL; P<0.05; Aβ40, 194.9 versus 181.2 pg/mL; P<0.01) and Aβ42 in participants with incident microbleeds (62.8 versus 60.4 pg/mL; P<0.05). CONCLUSIONS Plasma Aβ levels are associated with both presence and progression of SVD markers, suggesting that Aβ pathology might contribute to the development and progression of SVD. Plasma Aβ levels might thereby serve as inexpensive and noninvasive measure for identifying individuals with increased risk for progression of SVD.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - H Bea Kuiperij
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Iris Kersten
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Mayra I Bergkamp
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ingeborg W M van Uden
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Hugo Vanderstichele
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Erik Stoops
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Jurgen A H R Claassen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ewoud J van Dijk
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Marcel M Verbeek
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.).
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12
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Yin ZG, Wang QS, Yu K, Wang WW, Lin H, Yang ZH. Sex differences in associations between blood lipids and cerebral small vessel disease. Nutr Metab Cardiovasc Dis 2018; 28:28-34. [PMID: 29162363 DOI: 10.1016/j.numecd.2017.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/31/2017] [Accepted: 10/01/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Dyslipidemia predicts higher risk of coronary events and stroke and might be associated with cerebral small vessel disease (SVD). Previous studies linking blood lipids and SVD have yielded inconsistent results, which may be attributable to sex differences in lipids metabolism. The aim of this study was to investigate the relationships between blood lipids and SVD in neurologically healthy men and women. METHODS AND RESULTS Consecutive 817 people aged 50 years or more were enrolled and underwent magnetic resonance imaging scans to evaluate the periventricular white matter lesions (PVWMLs), deep white matter lesions (DWMLs) and silent brain infarction (SBI). Fasting total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, apolipoprotein A-1 (apoA-1) and apolipoprotein B were assessed. Multivariable logistic regression analyses were performed to determine the associations of blood lipids with PVWMLs, DWMLs and SBI. HDL-C (for PVWMLs: OR 0.36, 95% CI 0.19-0.71; for DWMLs: OR 0.35, 95% CI 0.20-0.63) and apoA-1 (for PVWMLs: OR 0.27, 95% CI 0.11-0.66; for DWMLs: OR 0.22, 95% CI 0.10-0.48) were inversely associated with the severity of PVWMLs and DWMLs in women but not in men after adjustment for age, hypertension, diabetes, current smoking, daily drinking, body mass index and uric acid. Additionally, no blood lipids were significantly associated with SBI. CONCLUSIONS Our findings demonstrate that sex differences may exist in the associations between lipids and SVD. HDL-C and apoA-1 levels were inversely associated with the severity of PVWMLs and DWMLs in women.
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Affiliation(s)
- Z-G Yin
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Q-S Wang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China.
| | - K Yu
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - W-W Wang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - H Lin
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Z-H Yang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
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van Agtmaal MJM, Houben AJHM, Pouwer F, Stehouwer CDA, Schram MT. Association of Microvascular Dysfunction With Late-Life Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2017; 74:729-739. [PMID: 28564681 PMCID: PMC5710252 DOI: 10.1001/jamapsychiatry.2017.0984] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/26/2017] [Indexed: 12/14/2022]
Abstract
Importance The etiologic factors of late-life depression are still poorly understood. Recent evidence suggests that microvascular dysfunction is associated with depression, which may have implications for prevention and treatment. However, this association has not been systematically reviewed. Objective To examine the associations of peripheral and cerebral microvascular dysfunction with late-life depression. Data Sources A systematic literature search was conducted in MEDLINE and EMBASE for and longitudinal studies published since inception to October 16, 2016, that assessed the associations between microvascular dysfunction and depression. Study Selection Three independent researchers performed the study selection based on consensus. Inclusion criteria were a study population 40 years of age or older, a validated method of detecting depression, and validated measures of microvascular function. Data Extraction and Synthesis This systematic review and meta-analysis has been registered at PROSPERO (CRD42016049158) and is reported in accordance with the PRISMA and MOOSE guidelines. Data extraction was performed by an independent researcher. Main Outcomes and Measures The following 5 estimates of microvascular dysfunction were considered in participants with or without depression: plasma markers of endothelial function, albuminuria, measurements of skin and muscle microcirculation, retinal arteriolar and venular diameter, and markers for cerebral small vessel disease. Data are reported as pooled odds ratios (ORs) by use of the generic inverse variance method with the use of random-effects models. Results A total of 712 studies were identified; 48 were included in the meta-analysis, of which 8 described longitudinal data. Data from 43 600 participants, 9203 individuals with depression, and 72 441 person-years (mean follow-up, 3.7 years) were available. Higher levels of plasma endothelial biomarkers (soluble intercellular adhesion molecule-1: OR, 1.58; 95% CI, 1.28-1.96), white matter hyperintensities (OR, 1.29; 95% CI, 1.19-1.39), cerebral microbleeds (OR, 1.18; 95% CI, 1.03-1.34), and cerebral (micro)infarctions (OR, 1.30; 95% CI, 1.21-1.39) were associated with depression. Among the studies available, no significant associations of albuminuria and retinal vessel diameters with depression were reported. Longitudinal data showed a significant association of white matter hyperintensities with incident depression (OR, 1.19; 95% CI, 1.09-1.30). Conclusions and Relevance This meta-analysis shows that both the peripheral and cerebral forms of microvascular dysfunction are associated with higher odds of (incident) late-life depression. This finding may have clinical implications because microvascular dysfunction might provide a potential target for the prevention and treatment of depression.
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Affiliation(s)
- Marnix J. M. van Agtmaal
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Alfons J. H. M. Houben
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Miranda T. Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
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14
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Kim J, Yoon SJ, Woo MH, Kim SH, Kim NK, Kim J, Kim OKJ, Oh SH. Differential impact of serum total bilirubin level on cerebral atherosclerosis and cerebral small vessel disease. PLoS One 2017; 12:e0173736. [PMID: 28319156 PMCID: PMC5358834 DOI: 10.1371/journal.pone.0173736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/24/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A low serum total bilirubin (T-bil) level is associated with an increased risk of atherosclerosis. However, the differential impact of the serum T-bil level on cerebral atherosclerosis and cerebral small vessel disease (SVD) is still unclear. METHODS We evaluated serum T-bil levels from 1,128 neurologically healthy subjects. Indices of cerebral atherosclerosis (extracranial arterial stenosis [ECAS] and intracranial arterial stenosis [ICAS]), and indices of SVD (silent lacunar infarct [SLI], and moderate-to-severe white matter hyperintensities [msWMH]) were evaluated by the use of brain magnetic resonance imaging (MRI) and MR angiography. RESULTS In logistic regression analysis after adjusting for confounding variables, subjects within middle T-bil (odds ratio [OR]: 0.63; 95% CI: 0.41-0.97) and high T-bil tertiles (OR: 0.54; 95% CI: 0.33-0.86) showed a lower prevalence of ECAS than those in a low T-bil tertile. Although subjects with a high T-bil tertile had a lower prevalence of ICAS than those with a low T-bil tertile, the statistical significance was marginal after adjusting for confounding variables. There were no significant differences in the proportions of subjects with SLI and msWMH across serum T-bil tertile groups. CONCLUSIONS The serum T-bil level is negatively associated with cerebral atherosclerosis, especially extracranial atherosclerosis, but not with SVD.
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Affiliation(s)
- Jonguk Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung-Jae Yoon
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Min-Hee Woo
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sang-Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Nam-Keun Kim
- Institute for Clinical Research, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - OK-Joon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
- * E-mail:
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Yang S, Cai J, Lu R, Wu J, Zhang M, Zhou X. Association Between Serum Cystatin C Level and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Acute Lacunar Stroke. J Stroke Cerebrovasc Dis 2016; 26:186-191. [PMID: 27727072 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/24/2016] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is associated with cerebral small vessel disease (cSVD). However, the relationship between serum cystatin C (CysC) level, a highly sensitive marker of impaired kidney function, and cSVD has not been fully understood. This study aimed to investigate the association between serum CysC level and total burden of cSVD on magnetic resonance imaging (MRI) in patients with acute lacunar stroke. MATERIALS AND METHODS A total of 210 patients with first-ever acute lacunar stroke occurring within 1 week after onset were included in this study. Serum CysC level, decreased estimated glomerular filtration rate (eGFR), and proteinuria were used to evaluate kidney function. The combined effect of the markers of cSVD on MRI, including lacunar, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces, were used to evaluate the comprehensive cSVD burden. RESULTS There is a positive association between total cSVD burden and hypertension, low eGFR level, and serum CysC level. After adjustments for potential confounders by ordinal logistic regression, elevated levels of CysC as well as impaired eGFR and the presence of proteinuria were correlated with the burden of total cSVD (odds ratio [OR] 2.633, 95% confidence interval [CI] 1.284-5.403; OR 2.442, 95% CI 1.213-4.918; and OR 2.151, 95% CI 1.162-3.983, respectively). CONCLUSIONS The elevated level of serum CysC is associated with the total burden of cSVD in patients with acute lacunar stroke independent of conventional risk factors.
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Affiliation(s)
- Song Yang
- Department of Neurology, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Jing Cai
- Department of Neuroscience, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Rulan Lu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China
| | - Jian Wu
- Department of Neurology, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China.
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Hwang M, Tudorascu DL, Nunley K, Karim H, Aizenstein HJ, Orchard TJ, Rosano C. Brain Activation and Psychomotor Speed in Middle-Aged Patients with Type 1 Diabetes: Relationships with Hyperglycemia and Brain Small Vessel Disease. J Diabetes Res 2016; 2016:9571464. [PMID: 26998494 PMCID: PMC4779538 DOI: 10.1155/2016/9571464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 01/26/2023] Open
Abstract
Slower psychomotor speed is very common in patients with type 1 diabetes mellitus (T1D), but the underlying mechanisms are not clear. We propose that hyperglycemia is associated with slower psychomotor speed via disruption of brain activation. Eighty-five adults (48% women, mean age: 49.0 years, mean duration: 40.8) with childhood onset T1D were recruited for this cross-sectional study. Median response time in seconds (longer = worse performance) and brain activation were measured while performing a psychomotor speed task. Exposure to hyperglycemia, measured as glycosylated hemoglobin A1c, was associated with longer response time and with higher activation in the inferior frontal gyrus and primary sensorimotor and dorsal cingulate cortex. Higher activation in inferior frontal gyrus, primary sensorimotor cortex, thalamus, and cuneus was related to longer response times; in contrast, higher activation in the superior parietal lobe was associated with shorter response times. Associations were independent of small vessel disease in the brain or other organs. In this group of middle-aged adults with T1D, the pathway linking chronic hyperglycemia with slower processing speed appears to include increased brain activation, but not small vessel disease. Activation in the superior parietal lobe may compensate for dysregulation in brain activation in the presence of hyperglycemia.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, University of Pittsburgh, 3600 Forbes Avenue, Plaza Level, Pittsburgh, PA 15213, USA
| | - Dana L. Tudorascu
- Department of Internal Medicine, Department of Psychiatry, and Department of Biostatistics, University of Pittsburgh, 200 Meyran Avenue, Suite 326, Pittsburgh, PA 15213, USA
| | - Karen Nunley
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 443, Pittsburgh, PA 15213, USA
| | - Helmet Karim
- Department of Bioengineering, University of Pittsburgh, 253 Sterling Plaza, Pittsburgh, PA 15213, USA
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Trevor J. Orchard
- Department of Epidemiology, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 467, Pittsburgh, PA 15213, USA
- *Caterina Rosano:
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Poggesi A, Pasi M, Pescini F, Pantoni L, Inzitari D. Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: A review. J Cereb Blood Flow Metab 2016; 36:72-94. [PMID: 26058695 PMCID: PMC4758546 DOI: 10.1038/jcbfm.2015.116] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/17/2015] [Accepted: 05/05/2015] [Indexed: 01/04/2023]
Abstract
The term cerebral small vessel disease (SVD) refers to a group of pathologic processes with various etiologies that affect small arteries, arterioles, venules, and capillaries of the brain. Magnetic resonance imaging (MRI) correlates of SVD are lacunes, recent small subcortical infarcts, white-matter hyperintensities, enlarged perivascular spaces, microbleeds, and brain atrophy. Endothelial dysfunction is thought to have a role in the mechanisms leading to SVD-related brain changes, and the study of endothelial dysfunction has been proposed as an important step for a better comprehension of cerebral SVD. Among available methods to assess endothelial function in vivo, measurement of molecules of endothelial origin in peripheral blood is currently receiving selective attention. These molecules include products of endothelial cells that change when the endothelium is activated, as well as molecules that reflect endothelial damage and repair. This review examines the main molecular factors involved in both endothelial function and dysfunction, and the evidence linking endothelial dysfunction with cerebral SVD, and gives an overview of clinical studies that have investigated the possible association between endothelial circulating biomarkers and SVD-related brain changes.
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Affiliation(s)
- Anna Poggesi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Marco Pasi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Pantoni
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Domenico Inzitari
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
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Lee HB, Kim J, Kim SH, Kim S, Kim OJ, Oh SH. Association between Serum Alkaline Phosphatase Level and Cerebral Small Vessel Disease. PLoS One 2015; 10:e0143355. [PMID: 26580067 PMCID: PMC4651565 DOI: 10.1371/journal.pone.0143355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 09/01/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Serum alkaline phosphatase (ALP) is a marker of vascular calcification. A high serum ALP level is associated with an increase in cardiovascular events, and predicts poor functional outcome in patients with stroke. We investigated whether serum ALP was associated with cerebral small vessel disease (cSVD) and large cerebral artery stenosis (LCAS). METHODS We evaluated vascular risk factors, brain magnetic resonance images (MRIs), and MR angiograms from 1,011 neurologically healthy participants. The presence of silent lacunar infarction (SLI) and moderate-to-severe cerebral white matter hyperintensities (MS-cWMH) were evaluated as indices of cSVD on brain MRIs. Findings of extracranial arterial stenosis (ECAS) or intracranial arterial stenosis (ICAS) were considered to be indices of LCAS on MR angiograms. RESULTS Subjects with SLI (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.27-3.42; p = 0.004) and MS-cWMH (OR: 1.48; 95% CI; 1.03-2.13, p = 0.036) were significantly more likely to have ALP levels in the third tertile (ALP ≥ 195 IU/L) than the first tertile (ALP ≤ 155 IU/L), after adjusting for cardiovascular risk factors. The mean serum ALP level was significantly higher in patients with SLI or MS-cWMH compared to patients without those findings. After adjustment for confounding factors, the multivariate model found that the statistical significance of serum ALP remained when the presence of SLI (OR: 1.05 per 10 IU/L increase in ALP; 95% CI: 1.02-1.08; p = 0.003) or MS-cWMH (OR: 1.03 per 10 IU/L increase in ALP; 95% CI: 1.00-1.06; p = 0.025) were added to the model. There were no differences in the proportions of patients with LCAS, ICAS, and ECAS across the serum ALP tertiles. CONCLUSIONS Our study of neurologically healthy participants found a positive association between serum ALP level and indicators of cSVD, but no association between serum ALP level and the indicators of LCAS.
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Affiliation(s)
- Han-Bin Lee
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Sang-Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Soonhag Kim
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung-si, South Korea
- Catholic Kwandong University International St. Mary’s Hospital, Incheon Metropolitan City, South Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
- * E-mail:
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Hagström E, Kilander L, Nylander R, Larsson EM, Michaëlsson K, Melhus H, Ahlström H, Johansson L, Lind L, Arnlöv J. Plasma parathyroid hormone is associated with vascular dementia and cerebral hyperintensities in two community-based cohorts. J Clin Endocrinol Metab 2014; 99:4181-9. [PMID: 25140397 DOI: 10.1210/jc.2014-1736] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In diseases with increased PTH such as hyperparathyroidism and chronic renal failure, dementia is common. Little is known of PTH and dementia in the community. OBJECTIVE We sought to investigate relations between PTH, clinical dementia and cerebral micro-vascular disease. SETTING AND DESIGN The Uppsala Longitudinal Study Of Adult Men (ULSAM) was prospective, baseline, 1991-1995; followup, 15.8 years. The Prospective Investigation Of The Vasculature In Uppsala Seniors (PIVUS) was cross-sectional, baseline, 2001. Both settings were community based. PARTICIPANTS AND MAIN OUTCOME MEASURE: In the ULSAM study of 998 men (age 71) the association between PTH and dementia was investigated. In the PIVUS study of 406 men and women (age 70) the relation between PTH and magnetic resonance imaging signs of cerebral small vascular disease was investigated. RESULTS During followup, 56 individuals were diagnosed with vascular, 91 with Alzheimer's, and 59 with other dementias. In Cox-regression analyses, higher PTH was associated with vascular dementia (hazard ratio per 1 SD increase of PTH, 1.41; P < .01), but not with other dementias. The top tertile of PTH accounted for 18.5% of the population-attributable risk for vascular dementia, exceeding all other risk factors. In linear regression analysis in PIVUS, PTH was associated with increasing white matter hyperintensities (WMHI), reflecting increasing burden of cerebral small vessel disease (1 SD PTH increase, 0.31 higher category of WMHI; P = .016). All models were adjusted for vascular risk factors and mineral metabolism. CONCLUSIONS In two community-based samples, PTH predicted clinically diagnosed vascular dementia as well as neuroimaging indices of cerebral small vessel disease. Our data suggest a role for PTH in the development of vascular dementia.
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Affiliation(s)
- Emil Hagström
- Uppsala Clinical Research Center (E.H., J.Ä.), Departments of Public Health and Caring Sciences/Geriatrics (L.K.), Radiology (R.N., E.-M.L., H.A., L.J.), Surgical Sciences (K.M.), and Medical Sciences (E.H., H.M., L.L., J.Ä.), Uppsala University, 75185 Uppsala, Sweden; and the School of Health and Social Studies (J.Ä.), Dalarna University, 79131 Falun, Sweden
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Ayrignac X, Magnin E, Wallon D, Guennoc AM, Lebrun-Fresnay C, Labauge P. [Vascular leukoencephalopathy in patients without vascular risk factor or NOTCH3 mutation: clinical and radiological findings]. Rev Neurol (Paris) 2013; 169:136-41. [PMID: 23394849 DOI: 10.1016/j.neurol.2012.05.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/08/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION White matter lesions seen on MR scan reflect small vessel disease of the brain; increasing age and high blood pressure are the main risk factors. In young patients without vascular risk factors, screening for CADASIL mutation has to be done. Our aim was to describe clinical as well as radiological features of a series of patients without NOTCH3 mutation with severe vascular leukoencephalopathy not explained by the presence of vascular risk factors. MATERIAL AND METHODS Inclusion criteria were grade 3 leukoencephalopathy according to the Fazekas scale, age<70years at onset, and negative screening for NOTCH3 gene. Patients with severe vascular risk factors or atherosclerosis were excluded. Clinical and MRI findings were analysed. RESULTS Eight patients (four men) were included, five did not have any vascular risk factor. Mean age at onset was 59.5years. Initial symptoms were progressive in six cases of eight cases. They consisted of astasia-abasia and progressively worsened; of note one patient died 4years after disease onset. Cerebral MRI disclosed marked atrophy in five patients out of eight, temporal lobe (two out of eight) and external capsule (five out of eight) involvement was moderate. Four patients did not have any other atherosclerosis lesion. Seven out of eight had no retinal microangiopathy. High blood pressure was identified in two patients. CONCLUSION The identification of vascular leukoencephalopathy in young patients without any vascular risk factors should lead the clinician to perform a complete work-up to search for treatable conditions including high blood pressure. Patients with vascular leukoencephalopathy usually present with astasia-abasia. In this context, cerebral MRI, cannot perfectly discriminate between patients with CADASIL from those with acquired small-vessel disease of the brain so that sequencing of NOTCH3 gene exons 2-24 is recommended.
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Affiliation(s)
- X Ayrignac
- Service de neurologie, hôpital Gui de Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
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