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Martinez-Majander N, Gordin D, Joutsi-Korhonen L, Salopuro T, Adeshara K, Sibolt G, Curtze S, Pirinen J, Liebkind R, Soinne L, Sairanen T, Suihko S, Lehto M, Sinisalo J, Groop PH, Tatlisumak T, Putaala J. Markers of early vascular aging are not associated with cryptogenic ischemic stroke in the young: A case-control study. J Stroke Cerebrovasc Dis 2022; 31:106647. [PMID: 35849915 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106647] [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: 05/16/2022] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to assess the association between covert atherosclerosis, arterial stiffness, and early-onset cryptogenic ischemic stroke (CIS) in a prospective case-control study. METHODS We enrolled 123 young CIS patients (median age 41 years; 42% women) and 123 age- and sex-matched controls. Carotid intima-media thickness (CIMT), Augmentation Index (AIx), central pulse wave velocity (PWV), and subendocardial viability ratio (SEVR) were compared between patients and controls. Conditional logistic regression was used adjusting for age, systolic blood pressure, diastolic blood pressure, current smoking, total cholesterol/high-density lipoprotein cholesterol (Total-C/HDL-C) ratio, and glycated albumin to assess the independent association between CIMT, arterial stiffness and CIS. RESULTS Patients with higher CIMT and PWV were older, more often men and they had more frequently well-documented risk factors, lower HDL and higher Total-C/HDL-C ratio compared to other tertiles. In univariate comparisons, we found no differences between patients and controls regarding CIMT, AIx, or PWV. In the entire cohort, patients had a significantly lower SEVR compared to controls (146.3%, interquartile range [IQR] 125.7-170.3 vs. 158.0%, IQR 141.3-181.0, P=0.010). SEVR was lower also in women compared to their controls (132.0%, IQR 119.4-156.1 vs. 158.7%, IQR 142.0-182.8, P=0.001) but no significant difference appeared between male patients and male controls. However, after adjusting for comorbidities and laboratory values these significant differences were lost (odds ratio [OR] 1.52, 95% confidence interval [CI] 0.47-4.91) in the entire cohort and OR 3.89, 95% CI 0.30-50.80 in women). CONCLUSIONS Higher CIMT and PWV were associated to higher age, male sex, and several well-documented cardiovascular risk factors. However, in this study we could not prove that either covert atherosclerosis or arterial stiffness contribute to pathogenesis of early-onset CIS.
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Affiliation(s)
- Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland.
| | - Daniel Gordin
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Lotta Joutsi-Korhonen
- Department of Clinical Chemistry, HUSLAB, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Titta Salopuro
- Department of Clinical Chemistry, HUSLAB, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Krishna Adeshara
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Jani Pirinen
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland; HUS Helsinki University Hospital, Porvoo Hospital Area, Internal Medicine, Finland; Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Finland
| | - Ron Liebkind
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Lauri Soinne
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Tiina Sairanen
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Satu Suihko
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Mika Lehto
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
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Inkeri J, Adeshara K, Harjutsalo V, Forsblom C, Liebkind R, Tatlisumak T, Thorn LM, Groop PH, Shams S, Martola J, Putaala J, Gordin D. Glycemic control is not related to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. Acta Diabetol 2022; 59:481-490. [PMID: 34778921 PMCID: PMC8917104 DOI: 10.1007/s00592-021-01821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
AIMS To determine if medium- and long-term blood glucose control as well as glycemic variability, which are known to be strong predictors of vascular complications, are associated with underlying cerebral small vessel disease (cSVD) in neurologically asymptomatic individuals with type 1 diabetes. METHODS A total of 189 individuals (47.1% men; median age 40.0, IQR 33.0-45.2 years) with type 1 diabetes (median diabetes duration of 21.7, IQR 18.3-30.7 years) were enrolled in a cross-sectional retrospective study, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. Glycated hemoglobin (HbA1c) values were collected over the course of ten years before the visit including a clinical examination, biochemical sampling, and brain magnetic resonance imaging. Markers of glycemic control, measured during the visit, included HbA1c, fructosamine, and glycated albumin. RESULTS Signs of cSVD were present in 66 (34.9%) individuals. Medium- and long-term glucose control and glycemic variability did not differ in individuals with signs of cSVD compared to those without. Further, no difference in any of the blood glucose variables and cSVD stratified for cerebral microbleeds (CMBs) or white matter hyperintensities were detected. Neither were numbers of CMBs associated with the studied glucose variables. Additionally, after dividing the studied variables into quartiles, no association with cSVD was observed. CONCLUSIONS We observed no association between glycemic control and cSVD in neurologically asymptomatic individuals with type 1 diabetes. This finding was unexpected considering the large number of signs of cerebrovascular pathology in these people after two decades of chronic hyperglycemia and warrants further studies searching for underlying factors of cSVD.
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Affiliation(s)
- Jussi Inkeri
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Krishna Adeshara
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Juha Martola
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jukka Putaala
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Eriksson MI, Summanen P, Gordin D, Forsblom C, Shams S, Liebkind R, Tatlisumak T, Putaala J, Groop PH, Martola J, Thorn LM. Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002274. [PMID: 34429281 PMCID: PMC8386215 DOI: 10.1136/bmjdrc-2021-002274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain's vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic retinopathy severity and cerebral small-vessel disease in type 1 diabetes. RESEARCH DESIGN AND METHODS For this cross-sectional study, we enrolled 189 participants with type 1 diabetes (median age 40 (33-45) years; 53% female; diabetes duration 21.6 (18.2-30.7) years) and 29 healthy age-matched and sex-matched controls as part of the Finnish Diabetic Nephropathy Study. Participants underwent a clinical investigation, brain MRI, and fundus imaging. Signs of cerebral small-vessel disease in brain MRIs were analyzed in relation to diabetic retinopathy severity (Early Treatment Diabetic Retinopathy Study (ETDRS) score). RESULTS In type 1 diabetes, participants with cerebral small-vessel disease had higher ETDRS scores (35 (20-61) vs 20 (20-35), p=0.022) and a higher prevalence of proliferative diabetic retinopathy than those without cerebral small-vessel disease (25% vs 9%, p=0.002). In adjusted analysis, proliferative diabetic retinopathy was associated with cerebral small-vessel disease (OR 2.57 (95% CI 1.04 to 6.35)). Median ETDRS score (35 (20-65) vs 20 (20-35), p=0.024) and proliferative diabetic retinopathy prevalence were higher (29% vs 13%, p=0.002) in participants with versus without cerebral microbleeds. ETDRS scores increased by number of cerebral microbleeds (p=0.001), both ETDRS score (OR 1.05 (95% CI 1.02 to 1.09)) and proliferative diabetic retinopathy (8.52 (95% CI 1.91 to 37.94)) were associated with >2 cerebral microbleeds in separate multivariable analysis. We observed no association with white matter hyperintensities or lacunar infarcts. CONCLUSIONS Presence of cerebral small-vessel disease on brain MRI, particularly cerebral microbleeds, is associated with the severity of diabetic retinopathy.
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Affiliation(s)
- Marika I Eriksson
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Paula Summanen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Radiology, Stanford Medicine, Stanford, California, USA
| | - Ron Liebkind
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Juha Martola
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Martinez-Majander N, Gordin D, Joutsi-Korhonen L, Salopuro T, Adeshara K, Sibolt G, Curtze S, Pirinen J, Liebkind R, Soinne L, Sairanen T, Sinisalo J, Lehto M, Groop PH, Tatlisumak T, Putaala J. Endothelial Dysfunction is Associated With Early-Onset Cryptogenic Ischemic Stroke in Men and With Increasing Age. J Am Heart Assoc 2021; 10:e020838. [PMID: 34227391 PMCID: PMC8483459 DOI: 10.1161/jaha.121.020838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to assess the association between endothelial function and early‐onset cryptogenic ischemic stroke (CIS), with subgroup analyses stratified by sex and age groups. Methods and Results We prospectively enrolled 136 consecutive patients aged 18 to 49 years (median age, 41 years; 44% women) with a recent CIS and 136 age‐ and sex‐matched (±5 years) stroke‐free controls. Endothelial function was measured with an EndoPAT 2000 device and analyzed as tertiles of natural logarithm of reactive hyperemia index with lower values reflecting dysfunction. We used conditional logistic regression adjusting for age, education, hypertension, diabetes mellitus, dyslipidemia, current smoking, heavy drinking, obesity, and diet score to assess the independent association between endothelial function and CIS. Patients in the lowest tertile of natural logarithm of reactive hyperemia index were more often men and they more frequently had a history of dyslipidemia; they were also more often obese, had a lower diet score, and lower high‐density lipoprotein cholesterol. In the entire cohort, we found no association in patients with endothelial function and CIS compared with stroke‐free controls. In sex‐ and age‐specific analyses, endothelial dysfunction was associated with CIS in men (adjusted odds ratio [OR], 3.50 for lowest versus highest natural logarithm of reactive hyperemia index tertile; 95% CI, 1.22–10.07) and in patients ≥41 years (OR, 5.78; 95% CI, 1.52–21.95). These associations remained significant when dyslipidemia was replaced with the ratio of total to high‐density lipoprotein cholesterol. Conclusions Endothelial dysfunction appears to be an independent player in early‐onset CIS in men and patients approaching middle age.
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Affiliation(s)
- Nicolas Martinez-Majander
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
| | - Daniel Gordin
- Abdominal Center Nephrology University of Helsinki and Helsinki University Central Hospital Helsinki Finland.,Folkhälsan Institute of GeneticsFolkhälsan Research Center Helsinki Finland.,Joslin Diabetes Center Harvard Medical School Boston MA
| | - Lotta Joutsi-Korhonen
- Coagulation Disorders Unit Department of Clinical Chemistry HUSLAB Laboratory ServicesHelsinki University Hospital Helsinki Finland
| | - Titta Salopuro
- Coagulation Disorders Unit Department of Clinical Chemistry HUSLAB Laboratory ServicesHelsinki University Hospital Helsinki Finland
| | - Krishna Adeshara
- Abdominal Center Nephrology University of Helsinki and Helsinki University Central Hospital Helsinki Finland.,Folkhälsan Institute of GeneticsFolkhälsan Research Center Helsinki Finland.,Clinical and Molecular Metabolism Faculty of Medicine Research Programs University of Helsinki Finland
| | - Gerli Sibolt
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
| | - Sami Curtze
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
| | - Jani Pirinen
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland.,Department of Cardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Finland.,Department of Clinical Physiology and Nuclear Medicine HUS Medical Imaging CenterHelsinki University Central Hospital and University of Helsinki Finland
| | - Ron Liebkind
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
| | - Lauri Soinne
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
| | - Tiina Sairanen
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Finland
| | - Mika Lehto
- Department of Cardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology University of Helsinki and Helsinki University Central Hospital Helsinki Finland.,Folkhälsan Institute of GeneticsFolkhälsan Research Center Helsinki Finland
| | - Turgut Tatlisumak
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland.,Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy at University of Gothenburg Sweden.,Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jukka Putaala
- Department of Neurology Helsinki University Hospital and Clinical NeurosciencesUniversity of Helsinki Finland
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Inkeri J, Tynjälä A, Forsblom C, Liebkind R, Tatlisumak T, Thorn LM, Groop PH, Shams S, Putaala J, Martola J, Gordin D. Carotid intima-media thickness and arterial stiffness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. Acta Diabetol 2021; 58:929-937. [PMID: 33743083 PMCID: PMC8187193 DOI: 10.1007/s00592-021-01678-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
AIMS To determine if arterial functional and structural changes are associated with underlying cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. METHODS We enrolled 186 individuals (47.8% men; median age 40.0, IQR 33.0-45.0 years) with type 1 diabetes (median diabetes duration of 21.6, IQR 18.2-30.3 years), and 30 age- and sex-matched healthy controls, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. All individuals underwent a biochemical work-up, brain magnetic resonance imaging (MRI), ultrasound of the common carotid arteries and arterial tonometry. Arterial structural and functional parameters were assessed by carotid intima-media thickness (CIMT), pulse wave velocity and augmentation index. RESULTS Cerebral microbleeds (CMBs) were present in 23.7% and white matter hyperintensities (WMHs) in 16.7% of individuals with type 1 diabetes. Those with type 1 diabetes and CMBs had higher median (IQR) CIMT 583 (525 - 663) μm than those without 556 (502 - 607) μm, p = 0.016). Higher CIMT was associated with the presence of CMBs (p = 0.046) independent of age, eGFR, ApoB, systolic blood pressure, albuminuria, history of retinal photocoagulation and HbA1c. Arterial stiffness and CIMT were increased in individuals with type 1 diabetes and WMHs compared to those without; however, these results were not independent of cardiovascular risk factors. CONCLUSIONS Structural, but not functional, arterial changes are associated with underlying CMBs in asymptomatic individuals with type 1 diabetes.
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Affiliation(s)
- Jussi Inkeri
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Jukka Putaala
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Martola
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Eriksson MI, Gordin D, Shams S, Forsblom C, Summanen P, Liebkind R, Tatlisumak T, Putaala J, Groop PH, Martola J, Thorn LM. Nocturnal Blood Pressure Is Associated With Cerebral Small-Vessel Disease in Type 1 Diabetes. Diabetes Care 2020; 43:e96-e98. [PMID: 32527801 DOI: 10.2337/dc20-0473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/02/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Marika I Eriksson
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paula Summanen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ron Liebkind
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland .,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Juha Martola
- Department of Radiology, Karolinska University Hospital; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Radiology, Helsinki University Hospital, Helsinki, Finland
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Claesson TB, Putaala J, Shams S, Salli E, Gordin D, Liebkind R, Forsblom C, Summanen PA, Tatlisumak T, Groop PH, Martola J, Thorn LM. Comparison of Manual Cross-Sectional Measurements and Automatic Volumetry of the Corpus Callosum, and Their Clinical Impact: A Study on Type 1 Diabetes and Healthy Controls. Front Neurol 2020; 11:27. [PMID: 32063882 PMCID: PMC7000520 DOI: 10.3389/fneur.2020.00027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/16/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
Background and purpose: Degenerative change of the corpus callosum might serve as a clinically useful surrogate marker for net pathological cerebral impact of diabetes type 1. We compared manual and automatic measurements of the corpus callosum, as well as differences in callosal cross-sectional area between subjects with type 1 diabetes and healthy controls. Materials and methods: This is a cross-sectional study on 188 neurologically asymptomatic participants with type 1 diabetes and 30 healthy age- and sex-matched control subjects, recruited as part of the Finnish Diabetic Nephropathy Study. All participants underwent clinical work-up and brain MRI. Callosal area was manually measured and callosal volume quantified with FreeSurfer. The measures were normalized using manually measured mid-sagittal intracranial area and volumetric intracranial volume, respectively. Results: Manual and automatic measurements correlated well (callosal area vs. volume: ρ = 0.83, p < 0.001 and mid-sagittal area vs. intracranial volume: ρ = 0.82, p < 0.001). We found no significant differences in the callosal measures between cases and controls. In type 1 diabetes, the lowest quartile of normalized callosal area was associated with higher insulin doses (p = 0.029) and reduced insulin sensitivity (p = 0.033). In addition, participants with more than two cerebral microbleeds had smaller callosal area (p = 0.002). Conclusion: Manually measured callosal area and automatically segmented are interchangeable. The association seen between callosal size with cerebral microbleeds and insulin resistance is indicative of small vessel disease pathology in diabetes type 1.
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Affiliation(s)
- Tor-Björn Claesson
- Department of Radiology, Visby Regional Hospital, Visby, Sweden.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Radiology, Stanford University, Stanford, CA, United States
| | - Eero Salli
- HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finland Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Ron Liebkind
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finland Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Paula A Summanen
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finland Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Juha Martola
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Radiology, Stanford University, Stanford, CA, United States
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finland Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
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8
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Hägg-Holmberg S, Dahlström EH, Forsblom CM, Harjutsalo V, Liebkind R, Putaala J, Tatlisumak T, Groop PH, Thorn LM. The role of blood pressure in risk of ischemic and hemorrhagic stroke in type 1 diabetes. Cardiovasc Diabetol 2019; 18:88. [PMID: 31288813 PMCID: PMC6617855 DOI: 10.1186/s12933-019-0891-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/25/2019] [Indexed: 12/23/2022] Open
Abstract
Background Hypertension is one of the strongest risk factors for stroke in the general population, while systolic blood pressure has been shown to independently increase the risk of stroke in type 1 diabetes. The aim of this study was to elucidate the association between different blood pressure variables and risk of stroke in type 1 diabetes, and to explore potential nonlinearity of this relationship. Methods We included 4105 individuals with type 1 diabetes without stroke at baseline, participating in the nationwide Finnish Diabetic Nephropathy Study. Mean age at baseline was 37.4 ± 11.9 years, median duration of diabetes 20.9 (interquartile range 11.5–30.4) years, and 52% were men. Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Based on these pulse pressure (PP) and mean arterial pressure (MAP) were calculated. Strokes were classified based on medical and autopsy records, as well as neuroimaging. Cox proportional hazard models were performed to study how the different blood pressure variables affected the risk of stroke and its subtypes. Results During median follow-up time of 11.9 (9.21–13.9) years, 202 (5%) individuals suffered an incident stroke; 145 (72%) were ischemic and 57 (28%) hemorrhagic. SBP, DBP, PP, and MAP all independently increased the risk of any stroke. SBP, PP, and MAP increased the risk of ischemic stroke, while SBP, DBP, and MAP increased the risk of hemorrhagic stroke. SBP was strongly associated with stroke with a hazard ratio of 1.20 (1.11–1.29)/10 mmHg. When variables were modeled using restricted cubic splines, the risk of stroke increased linearly for SBP, MAP, and PP, and non-linearly for DBP. Conclusions The different blood pressure variables are all independently associated with increased risk of stroke in individuals with type 1 diabetes. The risk of stroke, ischemic stroke, and hemorrhagic stroke increases linearly at blood pressure levels less than the current recommended treatment guidelines. Electronic supplementary material The online version of this article (10.1186/s12933-019-0891-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefanie Hägg-Holmberg
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Emma H Dahlström
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Carol M Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland. .,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. .,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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9
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Thorn LM, Shams S, Gordin D, Liebkind R, Forsblom C, Summanen P, Hägg-Holmberg S, Tatlisumak T, Salonen O, Putaala J, Martola J, Groop PH. Clinical and MRI Features of Cerebral Small-Vessel Disease in Type 1 Diabetes. Diabetes Care 2019; 42:327-330. [PMID: 30552131 DOI: 10.2337/dc18-1302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/29/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of cerebral small-vessel disease (SVD) in subjects with type 1 diabetes compared with healthy control subjects and to characterize the diabetes-related factors associated with SVD. RESEARCH DESIGN AND METHODS This substudy was cross-sectional in design and included 191 participants with type 1 diabetes and median age 40.0 years (interquartile range 33.0-45.1) and 30 healthy age- and sex-matched control subjects. All participants underwent clinical investigation and brain MRIs, assessed for cerebral SVD. RESULTS Cerebral SVD was more common in participants with type 1 diabetes than in healthy control subjects: any marker 35% vs. 10% (P = 0.005), cerebral microbleeds (CMBs) 24% vs. 3.3% (P = 0.008), white matter hyperintensities 17% vs. 6.7% (P = 0.182), and lacunes 2.1% vs. 0% (P = 1.000). Presence of CMBs was independently associated with systolic blood pressure (odds ratio 1.03 [95% CI 1.00-1.05], P = 0.035). CONCLUSIONS Cerebral SVD, CMBs in particular, is more common in young people with type 1 diabetes compared with healthy control subjects.
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Affiliation(s)
- Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Ron Liebkind
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Paula Summanen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Stefanie Hägg-Holmberg
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oili Salonen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Juha Martola
- Department of Radiology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Radiology, Helsinki University Hospital, Helsinki, Finland
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10
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Liebkind R, Gordin D, Strbian D, Meretoja A, Thorn LM, Hägg-Holmberg S, Forsblom C, Tatlisumak T, Groop PH, Putaala J. Diabetes and intracerebral hemorrhage: baseline characteristics and mortality. Eur J Neurol 2018; 25:825-832. [PMID: 29443444 DOI: 10.1111/ene.13603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Acknowledging the conflicting evidence for diabetes as a predictor of short- and long-term mortality following an intracerebral hemorrhage (ICH), we compared baseline characteristics and 30-day and long-term mortality between patients with and without diabetes after an ICH, paying special attention to differences between type 1 (T1D) and type 2 (T2D) diabetes. METHODS Patients with a first-ever ICH were followed for a median of 2.3 years. Adjusting for demographics, comorbidities and documented ICH characteristics increasing mortality after ICH, logistic regression analysis assessed factors associated with case fatality and 1-year survival among the 30-day survivors. Diabetes was compared with patients without diabetes in separate models as (i) any diabetes and (ii) T1D or T2D. RESULTS Of our 969 patients, 813 (83.9%) had no diabetes, 41 (4.2%) had T1D and 115 (11.9%) had T2D. Compared with patients without diabetes, those with diabetes were younger, more often men and more frequently had hypertension, coronary heart disease and chronic kidney disease, with similar ICH characteristics. Patients with T1D were younger, more often had chronic kidney disease and brainstem ICH, and less often had atrial fibrillation and lobar ICH, than did patients with T2D. Diabetes had no impact on case fatality. Any diabetes (odds ratio, 2.57; 1.19-5.52), T1D (odds ratio, 7.04; 1.14-43.48) and T2D (odds ratio, 2.32; 1.04-5.17) were independently associated with 1-year mortality. CONCLUSIONS Patients with ICH with diabetes exhibited a distinct pattern of comorbidities and disease characteristics with specific differences between T1D and T2D. Despite their younger age, T1D seems to carry a substantially higher likelihood of long-term mortality after an ICH than does T2D.
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Affiliation(s)
- R Liebkind
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - D Gordin
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - D Strbian
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Meretoja
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - L M Thorn
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - S Hägg-Holmberg
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - C Forsblom
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - T Tatlisumak
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Clinical Neurosciences, Sahlgrenska Academy at the University of Gothenburg and Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P-H Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - J Putaala
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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11
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Hägg-Holmberg S, Thorn LM, Forsblom CM, Gordin D, Elonen N, Harjutsalo V, Liebkind R, Putaala J, Tatlisumak T, Groop PH. Prognosis and Its Predictors After Incident Stroke in Patients With Type 1 Diabetes. Diabetes Care 2017; 40:1394-1400. [PMID: 28811283 DOI: 10.2337/dc17-0681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although patients with type 1 diabetes have a poor prognosis after a stroke, predictors of survival after an incident stroke in these patients are poorly studied. RESEARCH DESIGN AND METHODS In this observational study, a total of 144 patients of 4,083 with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study suffered an incident stroke in 1997-2010, and were followed for a mean 3.4 ± 3.1 years after the stroke. Information was recorded on hard cardiovascular events and death as a result of cardiovascular or diabetes-related cause, collectively referred to as vascular composite end point. Information was collected from medical records, death certificates, and the National Care Register of Health Care. Predictors at the time of the incident stroke were studied for the end points. RESULTS During follow-up, 104 (72%) patients suffered a vascular composite end point. Of these, 33 (32%) had a recurrent stroke, 33 (32%) a hard cardiovascular event, and 76 (53%) died of cardiovascular or diabetes-related causes, with an overall 1-year survival of 76% and 5-year survival of 58%. The predictors of a vascular composite end point were hemorrhagic stroke subtype (hazard ratio 2.03 [95% CI 1.29-3.19]), as well as chronic kidney disease stage 2 (2.48 [1.17-5.24]), stage 3 (3.04 [1.54-6.04]), stage 4 (3.95 [1.72-9.04]), and stage 5 (6.71 [3.14-14.34]). All-cause mortality increased with deteriorating kidney function. CONCLUSIONS Patients with type 1 diabetes with an incident stroke have a poor cardiovascular prognosis and a high risk of all-cause mortality. In particular, hemorrhagic stroke subtype and progression of diabetic kidney disease conveys worse outcome.
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Affiliation(s)
- Stefanie Hägg-Holmberg
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Carol M Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Nina Elonen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland .,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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12
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Martinez-Majander N, Gordin D, Pirinen J, Sinisalo J, Lehto M, Liebkind R, Kivioja R, Tatlisumak T, Groop PH, Putaala J. Abstract TP216: Subtle Cardiovascular Measures in Young-onset Cryptogenic Ischemic Stroke: A Prospective Case-control Study. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Worldwide, ≈1.3 million annual ischemic strokes (IS) occur in young adults (<50 years of age), of which up to 50% remain cryptogenic after a complete diagnostic work-up. In a pilot case-control study, we studied the value of arterial stiffness and related subendocardial viability in the search of underlying pathophysiology in these patients.
Methods:
We prospectively enrolled 51 patients aged 18-49 with recent imaging-positive cryptogenic IS and 51 age- and sex-matched stroke-free controls (NCT01934725). Measurements were done with an applanation tonometry (SphygmoCor). Augmentation Index (AIx) served as a measure of stiffness in small arteries. Aortic and brachial pulse wave velocities (aPWV; bPWV) reflected stiffness in large and intermediate-sized arteries, respectively. Subendocardial viability ratio (SEVR) was derived from radial artery waveform measures, reflecting myocardial oxygen supply and demand. Related-samples statistics were applied for univariate case-control analyses and linear regression to explore the relationship between parameters with significant association in case-control analysis.
Results:
AIx, aPWV, bPWV, heart rate, and systolic or diastolic blood pressures did not differ statistically between patients and controls. Mean SEVR was significantly lower in patients compared with controls (148±35 vs. 161±29, P=0.003). In patients, higher heart rate was inversely associated with SEVR (P<0.001). Age, sex, migraine with and without aura, smoking, and systolic and diastolic blood pressure showed no independent association with SEVR.
Conclusions:
To our knowledge, this is the first report to show an association between SEVR and stroke. Yet unrecognized subtle cardiovascular pathology may play a role in early-onset cryptogenic IS.
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Affiliation(s)
| | - Daniel Gordin
- Abdominal Cntr Nephrology, Helsinki Univ Hosp, Helsinki, Finland
| | - Jani Pirinen
- Dept of Neurology, Helsinki Univ Hosp and Clinical Neurosciences, Helsinki, Finland
| | - Juha Sinisalo
- Dept of Cardiology, Heart and Lung Cntr, Helsinki Univ Hosp, Helsinki, Finland
| | - Mika Lehto
- Dept of Cardiology, Heart and Lung Cntr, Helsinki Univ Hosp, Helsinki, Finland
| | - Ron Liebkind
- Dept of Neurology, Helsinki Univ Hosp and Clinical Neurosciences, Helsinki, Finland
| | - Reetta Kivioja
- Dept of Neurology, Helsinki Univ Hosp and Clinical Neurosciences, Helsinki, Finland
| | | | - Per-Henrik Groop
- Abdominal Cntr Nephrology, Helsinki Univ Hosp, Helsinki, Finland
| | - Jukka Putaala
- Dept of Neurology, Helsinki Univ Hosp and Clinical Neurosciences, Finland, Helsinki, Finland
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13
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Liebkind R, Gordin D, Strbian D, Meretoja A, Thorn L, Groop PH, Tatlisumak T, Putaala J. Abstract WP364: Diabetes Mellitus and Spontaneous Intracerebral Hemorrhage: Clinical Features and Mortality. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our previous findings suggest that ischemic stroke patients with either type 1 (T1D) or type 2 diabetes mellitus (T2D) exhibit a distinct risk factor and etiologic profile, and a worse vascular prognosis than do nondiabetic patients. We also showed that nonaneurysmal subarachnoid hemorrhage is rather a microvascular than macrovascular complication in T1D. Here, we aimed to compare risk factors, hematoma characteristics, and long-term mortality between diabetic and nondiabetic patients with spontaneous intracerebral hemorrhage (ICH) to provide information for patient management, counseling, and future research in these patient groups. Furthermore, we compared theses features between T1D and T2D patients.
Methods:
We included patients with first-ever ICH enrolled in the Helsinki ICH Study and in the Finnish Diabetic Nephropathy Study. Patients were followed using the national death registry. A Cox proportional hazards model adjusting for age at ICH onset, sex, and known ICH prognosticators_Glasgow Coma Scale (GCS) on admission, hematoma volume, infratentorial location, intraventricular hematoma_was constructed to assess, whether diabetes stands as an independent prognosticator.
Results:
A total of 972 patients were included, of which 813 (83.6%) were nondiabetic, 45 (4.6%) had T1D, and 120 (12.3%) T2D. Compared with nondiabetic patients, diabetic patients more often men, and they had more frequently hypertension and coronary heart disease. No difference emerged in GCS or hematoma volume, but diabetic patients more often had infratentorial ICH than nondiabetic patients. T1D patients were younger at ICH onset and they more often had brain stem ICH, but less often lobar ICH, than did T2D patients. Cumulative mortality at 12 months for nondiabetic patients was 34.0% (95% confidence interval 30.1-37.9%), for T1D 47.0% (31.3-62.7%), and for T2D 46.0% (36.2-55.8%). In multivariate Cox regression, diabetes was independently associated with higher risk of death (hazard ratio 1.42, 95% confidence interval 1.11-1.82, P=0.005).
Conclusions:
ICH patients with diabetes exhibit a distinct pattern of comorbidities and ICH characteristics compared with nondiabetic patients. Diabetes independently decreases the likelihood for survival after an ICH.
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Affiliation(s)
- Ron Liebkind
- Dept of Neurology, Neurology, Helsinki Univ Hosp, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Rsch Cntr, Helsinki, Finland Abdominal Cntr Nephrology, Univ of Helsinki and Helsinki Univ Hosp, Helsinki, Finland Rsch Programs Unit, Diabetes and Obesity, Univ of Helsinki, Helsinki, Finland
| | - Daniel Strbian
- Dept of Neurology, Neurology, Helsinki Univ Hosp, Helsinki, Finland
| | - Atte Meretoja
- Depts of Medicine and the Florey, Univ of Melbourne, Melbourne, Australia
| | - Lena Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Rsch Cntr, Helsinki, Finland Abdominal Cntr Nephrology, Univ of Helsinki and Helsinki Univ Hosp, Helsinki, Finland Rsch Programs Unit, Diabetes and Obesity, Univ of Helsinki, Helsinki, Finland
| | - Per Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Rsch Cntr, Helsinki, Finland Abdominal Cntr Nephrology, Univ of Helsinki and Helsinki Univ Hosp, Helsinki, Finland Rsch Programs Unit, Diabetes and Obesity, Univ of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Sahlgrenska Academy, Univ of Gothenburg, Sweden and Dept of Neurology, Sahlgrenska Univ Hosp, Gothenburg, Sweden
| | - Jukka Putaala
- Dept of Neurology, Neurology, Helsinki Univ Hosp, Helsinki, Finland
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Hägg S, Thorn LM, Forsblom CM, Gordin D, Saraheimo M, Tolonen N, Wadén J, Liebkind R, Putaala J, Tatlisumak T, Groop PH. Different risk factor profiles for ischemic and hemorrhagic stroke in type 1 diabetes mellitus. Stroke 2014; 45:2558-62. [PMID: 25061078 DOI: 10.1161/strokeaha.114.005724] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Despite the fact that patients with type 1 diabetes mellitus have a markedly increased risk of experiencing a stroke, independent risk factors for stroke and its subtypes in these patients have remained unclear. METHODS A total of 4083 patients with type 1 diabetes mellitus from the Finnish Diabetic Nephropathy (FinnDiane) Study, without a history of stroke at baseline, were included. Strokes were classified based on medical files and brain imaging. At baseline, mean age was 37.4±11.8 years, duration of diabetes mellitus was 20.0 (11.0-30.0) years, and 51% were men. During 9.0±2.7 years (36 680 patient-years) of follow-up, 105 patients experienced an ischemic stroke and 44 a hemorrhagic stroke. Cox proportional hazards analyses were performed to determine independent risk factors. RESULTS Independent risk factors for ischemic stroke were duration of diabetes mellitus, presence of diabetic nephropathy, higher hemoglobin A1c, higher systolic blood pressure, insulin resistance, and history of smoking, whereas sex, lipids, high-sensitivity C-reactive protein, and the metabolic syndrome were not associated with an increased risk. Diabetic nephropathy, severe diabetic retinopathy, higher systolic blood pressure, and lower body mass index were independently associated with hemorrhagic stroke. CONCLUSIONS The risk factor profile for ischemic stroke seems partly different from that of hemorrhagic stroke in patients with type 1 diabetes mellitus.
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Affiliation(s)
- Stefanie Hägg
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Lena M Thorn
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Carol M Forsblom
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Daniel Gordin
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Markku Saraheimo
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Nina Tolonen
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Johan Wadén
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Ron Liebkind
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Jukka Putaala
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Turgut Tatlisumak
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.)
| | - Per-Henrik Groop
- From the Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); Division of Nephrology, Department of Medicine (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.) and Department of Neurology (R.L., J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (S.H., L.M.T., C.M.F., D.G., M.S., N.T., J.W., P.-H.G.); and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia (P.-H.G.).
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Hägg S, Thorn LM, Putaala J, Liebkind R, Harjutsalo V, Forsblom CM, Gordin D, Tatlisumak T, Groop PH. Incidence of stroke according to presence of diabetic nephropathy and severe diabetic retinopathy in patients with type 1 diabetes. Diabetes Care 2013; 36:4140-6. [PMID: 24101700 PMCID: PMC3836162 DOI: 10.2337/dc13-0669] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is associated with a markedly increased risk of stroke, but only a few studies on the incidence of stroke in type 1 diabetes exist. Therefore, we assessed the incidence of stroke in patients with type 1 diabetes and studied the impact of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) on this risk. RESEARCH DESIGN AND METHODS We studied 4,083 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. Mean age was 37.4 ± 11.8 years, duration of diabetes was 21.6 ± 12.1 years, and 52% were men. Strokes were identified from medical records, death certificates, and the National Hospital Discharge Register and classified based on medical files and brain images. RESULTS During 36,680 person-years of follow-up, 149 (4%) patients suffered an incident stroke (105 infarctions and 44 hemorrhages). Of the infarctions, 58 (55%) were lacunar. The incidence of stroke, cerebral infarction, and cerebral hemorrhage was 406 (95% CI 344-477), 286 (234-347), and 120 (87-161) per 100,000 person-years, respectively. In an adjusted analysis, microalbuminuria increased the risk of stroke with a hazard ratio (HR) of 3.2 (1.9-5.6), macroalbuminuria 4.9 (2.9-8.2), and end-stage renal disease 7.5 (4.2-13.3), and SDR increased the risk with an HR of 3.0 (1.9-4.5). The risk of cerebral infarction, cerebral hemorrhage, and lacunar infarction increased in a similar manner. The proportion of lacunar versus nonlacunar infarction did not change across DN groups. CONCLUSIONS The presence of SDR and DN, independently, increases the risk of stroke, cerebral infarction, and cerebral hemorrhage in patients with type 1 diabetes.
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Korja M, Thorn LM, Hägg S, Putaala J, Liebkind R, Harjutsalo V, Forsblom CM, Gordin D, Tatlisumak T, Groop PH. Subarachnoid hemorrhage in type 1 diabetes: a prospective cohort study of 4,083 patients with diabetes. Diabetes Care 2013; 36:3754-8. [PMID: 23877984 PMCID: PMC3816906 DOI: 10.2337/dc13-0260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate for the first time the incidence of subarachnoid hemorrhage (SAH) in type 1 diabetes. RESEARCH DESIGN AND METHODS Using the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study cohort of 4,083 patients with type 1 diabetes (mean age of 37.4 ± 11.8 years at enrollment), we analyzed the incidence of first-ever SAH events. RESULTS During the follow-up time of 36,680 person-years (median 9.4 years), 15 patients with type 1 diabetes experienced an aneurysmal or nonaneurysmal SAH, and thus the crude incidence of SAH was 40.9 (95% CI 22.9-67.4) per 100,000 person-years. One patient had a verified aneurysmal SAH, and four patients died suddenly of an SAH, which was most likely caused by an aneurysm. SAHs in 10 out of 15 patients were classified as nonaneurysmal SAH, and thus the crude incidence of nonaneurysmal SAH was 27.3 (13.1-50.1) per 100,000 person-years. None of the nonaneurysmal SAHs were fatal. In univariate analysis, current smokers had a hazard ratio of 4.82 (95% CI 1.31-17.81) for nonaneurysmal SAH. CONCLUSIONS The incidence of nonaneurysmal SAH is high among patients with type 1 diabetes. Our findings suggest that nonaneurysmal SAH is a distinct new microvascular complication in type 1 diabetes.
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Artto V, Putaala J, Strbian D, Meretoja A, Piironen K, Liebkind R, Silvennoinen H, Atula S, Häppölä O. Stroke mimics and intravenous thrombolysis. Ann Emerg Med 2011; 59:27-32. [PMID: 22000770 DOI: 10.1016/j.annemergmed.2011.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The necessity for rapid administration of intravenous thrombolysis in patients with acute ischemic stroke may lead to treatment of patients with conditions mimicking stroke. We analyze stroke patients treated with intravenous thrombolysis in our center to characterize cases classified as stroke mimics. METHODS We identified and reviewed all cases with a diagnosis other than ischemic stroke in our large-scale single-center stroke thrombolysis registry. We compared these stroke mimics with patients with neuroimaging-negative and neuroimaging-positive ischemic stroke results. RESULTS Among 985 consecutive intravenous thrombolysis-treated patients, we found 14 stroke mimics (1.4%; 95% confidence interval 0.8% to 2.4%), 694 (70.5%) patients with neuroimaging-positive ischemic stroke results, and 275 (27.9%) patients with neuroimaging-negative ischemic stroke results. Stroke mimics were younger than patients with neuroimaging-negative or -positive ischemic stroke results. Compared with patients with neuroimaging-positive ischemic stroke results, stroke mimics had less severe symptoms at baseline and better 3-month outcome. No differences appeared in medical history or clinical features between stroke mimics and patients with neuroimaging-negative ischemic stroke results. None of the stroke mimics developed symptomatic intracerebral hemorrhage compared with 63 (9.1%) among patients with neuroimaging-positive ischemic stroke results and 6 (2.2%) among patients with neuroimaging-negative ischemic stroke results. CONCLUSION Stroke mimics were infrequent among intravenous thrombolysis-treated stroke patients in this cohort, and their treatment did not lead to harmful complications.
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Affiliation(s)
- Ville Artto
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
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18
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Putaala J, Haapaniemi E, Gordin D, Liebkind R, Groop PH, Kaste M, Tatlisumak T. Factors associated with impaired kidney function and its impact on long-term outcome in young ischemic stroke. Stroke 2011; 42:2459-64. [PMID: 21737795 DOI: 10.1161/strokeaha.110.612721] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE After ischemic stroke, kidney dysfunction is linked to poor outcomes in the elderly, but regarding young patients, data are lacking. METHODS We investigated estimated glomerular filtration rate (eGFR) on admission according to the Modification of Diet in Renal Disease equation in 958 consecutive patients aged 15 to 49 years with their first-ever ischemic stroke. Logistic regression adjusted for demographics and stroke risk factors served to identify factors related to low (<60) and high (>120 mL/min/1.73 m(2)) eGFR. In the long-term follow-up (mean, 8.9±3.8 years) study, Cox proportional hazards analysis described the association between eGFR and the following end points: nonfatal/fatal ischemic stroke; composite vascular event of any stroke, myocardial infarction, revascularization/other arterial occlusive event, or vascular death; and death of any cause. RESULTS Estimated GFR was normal in 809 (84.4%), low in 43 (4.5%), and high in 106 (11.1%) patients. Type 1 diabetes (OR, 18.84; 95% CI, 8.65 to 41.03), hypertension (4.29; 1.94 to 9.48), and cardiovascular disease (2.66; 1.19 to 5.96) were independently associated with low eGFR. Type 2 diabetes (3.82; 1.93 to 7.55), lower age (0.95 per year; 0.93 to 0.98), and male gender (1.74; 1.08 to 2.82) were associated with high eGFR. Both low (hazard ratio, 5.73; 95% CI, 3.54 to 9.25) and high eGFR (1.78; 1.01 to 3.14) were associated with long-term mortality when adjusted for age, gender, risk factors, stroke severity, and subtype. No independent association appeared between eGFR and vascular events. CONCLUSIONS Despite their different associated risk factors in our young patient cohort, both low and high eGFR predicted long-term mortality after ischemic stroke.
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Affiliation(s)
- Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290, Helsinki, Finland.
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Putaala J, Liebkind R, Gordin D, Thorn LM, Haapaniemi E, Forsblom C, Groop PH, Kaste M, Tatlisumak T. Diabetes mellitus and ischemic stroke in the young: Clinical features and long-term prognosis. Neurology 2011; 76:1831-7. [DOI: 10.1212/wnl.0b013e31821cccc2] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Putaala J, Sairanen T, Meretoja A, Lindsberg PJ, Tiainen M, Liebkind R, Strbian D, Atula S, Artto V, Rantanen K, Silvonen P, Piironen K, Curtze S, Häppölä O, Mustanoja S, Pitkäniemi J, Salonen O, Silvennoinen H, Soinne L, Kuisma M, Tatlisumak T, Kaste M. Post-Thrombolytic Hyperglycemia and 3-Month Outcome in Acute Ischemic Stroke. Cerebrovasc Dis 2011; 31:83-92. [PMID: 21079397 DOI: 10.1159/000321332] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/01/2010] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jukka Putaala
- Molecular Neurology Research Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 4, Helsinki, Finland.
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Liebkind R, Putaala J, Leppä M, Oula J, Tatlisumak T. Spinal Epidural Hematoma as a Complication of Intravenous Thrombolysis in an Acute Ischemic Stroke Patient. Case Rep Neurol 2010; 2:32-36. [PMID: 20689632 PMCID: PMC2914369 DOI: 10.1159/000313637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An 80-year-old white male suffered a stroke, fell to the floor, and suffered acute right hemiparesis and facial palsy. After an intravenous alteplase infusion 2.5 h later, the patient first complained of numbness in his right arm, then neck pain, followed by left leg numbness and slowly progressing paraparesis. MRI of the spine demonstrated an acute spinal dorsal epidural hematoma extending from the C6 to the T6 level; 12 h later, he underwent hematoma evacuation and laminectomy. Three months after surgery, the patient was paraplegic with moderate sensory loss below mamillary level. Acute ischemic stroke is often associated with a sudden fall, which, after thrombolysis, may result in unusual hemorrhagic complications.
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Affiliation(s)
- Ron Liebkind
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Liebkind R, Tatlisumak E, Wiksten M, Tatlisumak T. WITHDRAWN: Temporal and spatial expression patterns of laminins in ischemic adult rat brain. Neuroscience 2007; 152:338-345. [PMID: 18291595 DOI: 10.1016/j.neuroscience.2007.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 09/07/2007] [Accepted: 09/16/2007] [Indexed: 12/01/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at (http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- R Liebkind
- The Brain Laboratory, Department of Biological and Environmental Sciences (Physiology), University of Helsinki, Helsinki, Finland; Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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Wiksten M, Väänänen AJ, Liebkind R, Liesi P. Regeneration of adult rat spinal cord is promoted by the soluble KDI domain of gamma1 laminin. J Neurosci Res 2005; 78:403-10. [PMID: 15468336 DOI: 10.1002/jnr.20159] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Regeneration in the central nervous system (CNS) of adult mammals is hampered by formation of a glial scar and by proteins released from the myelin sheaths of injured neuronal pathways. Our recent data indicate that the KDI (Lys-Asp-Ile) domain of gamma1 laminin neutralizes both glial- and myelin-derived inhibitory signals and promotes survival and neurite outgrowth of cultured human spinal cord neurons. We show that after complete transection of the adult rat spinal cord, animals receiving onsite infusion of the KDI domain via osmotic mini-pumps recover and are able to sustain their body weights and walk with their hindlimbs. Animals treated with placebo suffer from irreversible hindlimb paralysis. Microscopic and molecular analyses of the spinal cords indicate that the KDI domain reduces tissue damage at the lesion site and enables neurite outgrowth through the injured area to effect functional recovery of the initially paralyzed animals. That the KDI domain enhances regeneration of acute spinal cord injuries in the adult rat suggests that it may be used to promote regeneration of spinal cord injuries in humans.
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Affiliation(s)
- Markus Wiksten
- The Brain Laboratory, Department of Biological and Environmental Sciences (Physiology), 00014 University of Helsinki, Helsinki, Finland
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Möykkynen T, Liebkind R, Sjöberg J, Korpi ER, Liesi P. The neuroprotective KDI domain of γ1-laminin is a universal and potent inhibitor of ionotropic glutamate receptors. J Neurosci Res 2005; 81:797-804. [PMID: 16044429 DOI: 10.1002/jnr.20523] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous work from this laboratory indicates that the KDI (Lys-Asp-Ile) domain of gamma 1-laminin promotes functional regeneration of adult rat spinal cord injuries and protects adult rat hippocampal neurons against massive neuronal death induced by intracerebral injection of the glutamate analogue kainic acid. In the present study, we used patch clamp recordings on cultured human embryonic neocortical neurons and HEK 293 cells expressing recombinant glutamate receptor subunits to study a putative interaction of the KDI with the glutamate system. We show that the KDI domain of gamma 1-laminin is a universal and potent inhibitor of AMPA, kainate, and NMDA subclasses of glutamate receptors, with a noncompetitive action on the AMPA receptor channel activity. Glutamate neurotoxicity plays a key role in both CNS trauma and neurodegenerative disorders, so this unexpected, novel function of the gamma 1-laminin-derived tripeptide may prove clinically valuable in treatment of CNS trauma and/or disease.
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Affiliation(s)
- Tommi Möykkynen
- Institute of Biomedicine (Pharmacology), Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
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Wiksten M, Väänänen A, Liebkind R, Rauhala P, Liesi P. Soluble KDI domain of γ1 laminin protects adult hippocampus from excitotoxicity of kainic acid. J Neurosci Res 2004; 78:411-9. [PMID: 15468332 DOI: 10.1002/jnr.20158] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent data indicate that the soluble KDI domain of gamma1 laminin promotes survival and neurite outgrowth of human central neurons in vitro (Liebkind et al.[2003] J Neurosci Res 73:637-643), and seems to neutralize both glia- and myelin-derived signals that hamper regeneration in the central nervous system (CNS) of adult mammals. We show that damage of adult rat neocortical and hippocampal areas by a stereotaxic injection of kainic acid (KA) is prevented by a preceding injection of the soluble KDI domain. In the presence of the KDI domain, both neocortical and hippocampal areas show extensive gliosis but have viable neurons and glial cells, which are absent and the areas fully destroyed after injection of KA alone. This result indicates that the KDI domain of the gamma1 laminin protects the CNS against excitotoxic insults and promotes survival of both neurons and glial cells. The KDI domain may thus be a potential drug to prevent CNS damage induced by neurodegenerative disorders, mechanical injury, or ischemia.
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Affiliation(s)
- Markus Wiksten
- The Brain Laboratory, Department of Biological and Environmental Sciences (Physiology), 00014 University of Helsinki, Helsinki, Finland
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Abstract
UNLABELLED Nitroxyl anion or its conjugate acid (NO-/HNO) and nitric oxide (NO) may both have pro-oxidative and cytotoxic properties. Superoxide dismutase (SOD) enzyme has been shown to convert reversibly HNO to NO. Mutations found in the SOD enzyme in some familial amyotrophic lateral sclerosis (ALS) patients affect redox properties of the SOD enzyme in a manner, which may affect the equilibrium between NO and HNO. Therefore, we studied the effects of HNO releasing compound, Angeli's salt (AS), on both motor and sensory functions after intrathecal administration in the lumbar spinal cord of a male rat. These functions were measured by rotarod, spontaneous activity, paw- and tail-flick tests. In addition, we compared the effect of AS to NO releasing papanonoate, old AS solution and sulphononoate in the motor performance test. The effect of intrathecal delivery of AS on the markers of the spinal cord injury and oxidative/nitrosative stress were further studied. RESULTS Freshly prepared AS (5 or 10 micromol), but not papanonoate, caused a marked decrease in the rotarod performance 3-7 days after the intrathecal administration. The peak motor deficiency was noted 3 days after AS (5 micromol) delivery. Old, degraded, AS solution and nitrous oxide releasing sulphononoate did not decrease motor performance in the rotarod test. AS did not affect the sensory stimulus evoked responses as measured by the paw-flick and tail-flick tests. Immunohistological examination revealed that AS caused injury related changes in the expression of glial fibrillary acidic protein (GFAP), fibroblast growth factor (FGF-2) and laminins in the spinal cord. Moreover, AS increased nitrotyrosine immunoreactivity in the spinal motor neurons. Therefore, we conclude that AS, but not NO releasing papanonoate, causes motor neuron injury but does not affect the function of sensory nerves in behavioural tests.
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Affiliation(s)
- Antti J Väänänen
- Institute of Biomedicine (Pharmacology), Biomedicum Helsinki, P.O. Box 63, University of Helsinki 00014, Helsinki, Finland
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Puska P, Harju M, Liebkind R. Peripapillary atrophy in the unilateral exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2004; 242:301-5. [PMID: 14747950 DOI: 10.1007/s00417-003-0843-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 09/08/2003] [Revised: 11/27/2003] [Accepted: 11/28/2003] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the areas of peripapillary atrophy between fellow eyes in patients with unilateral exfoliation syndrome. METHODS Topographic measurements for peripapillary atrophy and the optic nerve head with confocal scanning laser ophthalmoscopy, using the Heidelberg Retina Tomograph were performed on 45 nonglaucomatous patients with unilateral exfoliation syndrome. The area of peripapillary atrophy was divided into an alpha and a beta zone. The areas of alpha and beta peripapillary atrophy and their angular extents around the disc were measured. The frequency distributions of the alpha and beta areas and their largest radial extents at different positions around the disc were calculated. RESULTS An alpha area was detected in 84% of the exfoliative and 89% of the nonexfoliative fellow eyes, and a beta area in 31% and 42% of eyes, respectively. The exfoliative and the fellow nonexfoliative eyes did not differ in the sizes of the alpha (0.43+/-0.46 vs 0.33+/-0.18 mm(2), P=0.68) and beta (0.14+/-0.30 vs 0.17+/-0.34 mm(2), P=0.96) areas of peripapillary atrophy. The angular extents, the locations of the largest radial extent, and the frequency distributions of the alpha and beta peripapillary atrophy areas were similar in fellow eyes. CONCLUSION Exfoliation syndrome itself is not a risk factor for peripapillary atrophy.
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Affiliation(s)
- Päivi Puska
- Helsinki University Eye Hospital, Haartmaninkatu 4 C, PO Box 220, 00029, HYKS, Finland.
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Liebkind R, Laatikainen T, Liesi P. Is the soluble KDI domain of gamma1 laminin a regeneration factor for the mammalian central nervous system? J Neurosci Res 2003; 73:637-43. [PMID: 12929131 DOI: 10.1002/jnr.10692] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Regeneration of adult mammalian CNS is poor as a result of environmental factors that prevent axon growth. The major factors hampering regeneration of central axons include proteins released from the damaged myelin sheets of the injured neuronal pathways and formation of the glial scar. By using an experimental model of human CNS injury, we show that survival and neurite outgrowth of human central neurons are significantly enhanced by the soluble KDI domain of gamma1 laminin. Our results indicate that the KDI domain appears to neutralize both glia-derived inhibitory signals and inhibitory molecules released from the myelin of the adult human spinal cord. We propose that the KDI domain may enhance regeneration of injuries in the adult mammalian CNS.
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Affiliation(s)
- Ron Liebkind
- The Brain Laboratory, Institute of Biomedicine (Anatomy), Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
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Wiksten M, Liebkind R, Laatikainen T, Liesi P. Gamma 1 laminin and its biologically active KDI-domain may guide axons in the floor plate of human embryonic spinal cord. J Neurosci Res 2003; 71:338-52. [PMID: 12526023 DOI: 10.1002/jnr.10495] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Immunocytochemistry, in situ hybridization and Matrigel-embedded cultures were used to investigate the distribution of laminins during development of the human embryonic spinal cord (7-11 weeks). Our results indicate that alpha 1, beta 1, beta 3 and gamma 1 laminins localize as punctate deposits in the floor plate region in association with commissural fibers crossing the ventral midline. In addition, the neurite outgrowth domain of gamma 1 laminin accumulates heavily in the floor plate region, in the notochord and in GFAP-immunoreactive glial fibers of the embryonic spinal cord. In culture experiments, the biologically active KDI-domain of gamma 1 laminin selectively attracted directional outgrowth of neurites from explants of the dorsal spinal cord. The spatial and temporal colocalization of punctate deposits of laminins with nerve fibers crossing the ventral midline, and the guidance of neurites by the KDI-peptide domain, indicate that laminins, specifically the gamma 1 laminin, may be involved in guidance of axons during embryonic development of the human spinal cord.
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Affiliation(s)
- Markus Wiksten
- The Brain Laboratory, Biomedicum Helsinki, Institute of Biomedicine (Anatomy), University of Helsinki, Helsinki, Finland
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