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Biomedical subjects

Gavin W Britz

Publications and source records attributed to Gavin W Britz.

At least 19 recordsLinked to original sources

RNA/DNA Binding Protein TDP43 Regulates DNA Mismatch Repair Genes with Implications for Genome Stability.

TDP43 is an RNA/DNA binding protein increasingly recognized for its role in neurodegenerative conditions, including amyotrophic lateral sclerosis and frontotemporal dementia (FTD). As characterized by its aberrant nuclear export and cytoplasmic aggregation, TDP43 proteinopathy is a hallmark feature in over 95% of ALS/FTD cases, leading to the formation of detrimental cytosolic aggregates and a reduction in nuclear functionality within neurons. Building on our prior work linking TDP43 proteinopathy to the accumulation of DNA double-strand breaks (DSBs) in neurons, the present investigation uncovers a novel regulatory relationship between TDP43 and DNA mismatch repair (MMR) gene expressions. Here, we show that TDP43 depletion or overexpression directly affects the expression of key MMR genes. Alterations include MLH1, MSH2, MSH3, MSH6, and PMS2 levels across various primary cell lines, independent of their proliferative status. Our results specifically establish that TDP43 selectively influences the expression of MLH1 and MSH6 by influencing their alternative transcript splicing patterns and stability. We furthermore find aberrant MMR gene expression is linked to TDP43 proteinopathy in two distinct ALS mouse models and post-mortem brain and spinal cord tissues of ALS patients. Notably, MMR depletion resulted in the partial rescue of TDP43 proteinopathy-induced DNA damage and signaling. Moreover, bioinformatics analysis of the TCGA cancer database reveals significant associations between TDP43 expression, MMR gene expression, and mutational burden across multiple cancers. Collectively, our findings implicate TDP43 as a critical regulator of the MMR pathway and unveil its broad impact on the etiology of both neurodegenerative and neoplastic pathologies.

Amyotrophic lateral sclerosis↗

Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial.

BACKGROUND: Traumatic brain injuries represent an important and costly health problem. Supplemental magnesium positively affects many of the processes involved in secondary injury after traumatic brain injury and consistently improves outcome in animal models. We aimed to test whether treatment with magnesium favourably affects outcome in head-injured patients. METHODS: In a double-blind trial, 499 patients aged 14 years or older admitted to a level 1 regional trauma centre between August, 1998, and October, 2004, with moderate or severe traumatic brain injury were randomly assigned one of two doses of magnesium or placebo within 8 h of injury and continuing for 5 days. Magnesium doses were targeted to achieve serum magnesium ranges of 1.0-1.85 mmol/L or 1.25-2.5 mmol/L. The primary outcome was a composite of mortality, seizures, functional measures, and neuropsychological tests assessed up to 6 months after injury. Analyses were done according to the intention-to-treat principle. This trial is registered with , number . FINDINGS: Magnesium showed no significant positive effect on the composite primary outcome measure at the higher dose (mean=55 average percentile ranking on magnesium vs 52 on placebo, 95% CI for difference -7 to 14; p=0.70). Those randomly assigned magnesium at the lower dose did significantly worse than those assigned placebo (48 vs 54, 95% CI -10.5 to -2; p=0.007). Furthermore, there was higher mortality with the higher magnesium dose than with placebo. Other major medical complications were similar between groups, except for a slight excess of pulmonary oedema and respiratory failure in the lower magnesium target group. No subgroups were identified in which magnesium had a significantly positive effect. INTERPRETATION: Continuous infusions of magnesium for 5 days given to patients within 8 h of moderate or severe traumatic brain injury were not neuroprotective and might even have a negative effect in the treatment of significant head injury.

Adolescent↗

Postischemic augmentation of conducted dilation in cerebral arterioles.

BACKGROUND AND PURPOSE: Conducted vasomotor responses likely play an important role in cerebrovascular regulation, but it is unclear how these responses may be affected by ischemia. The purpose of this study was to evaluate the hypothesis that cerebral ischemia and reperfusion (I/R) alters vascular conduction in cerebral arterioles. METHODS: Middle cerebral artery occlusion (MCAO) was induced by an intraluminal filament technique in 4 groups of rats: (A) 2-hour MCAO/24-hour reperfusion (n=14); (B) 2-hour MCAO/1-hour reperfusion (n=7); (C) 1-hour MCAO/24-hour reperfusion (n=6); and (D) 1-hour MCAO/1-hour reperfusion (n=5). Neurological status and infarction (2,3,5-triphenyltetrazolium chloride staining) were evaluated after I/R. Conducted vasomotor responses were assessed in intracerebral branches of the MCA, by following the longitudinal spread of vasodilation or vasoconstriction to localized microapplication of ATP or adenosine. RESULTS: Local microapplication of ATP evoked a biphasic constriction (17+/-3%) and dilation (7+/-2%) response, whereas adenosine elicited only dilation (11+/-2%). These local responses spread longitudinally along sham-control arterioles (1 mm conduction distance) with rapid spatial decay. Ischemia followed by 24-hour reperfusion (groups A and C) led to a marked potentiation of conducted dilation responses: dilation to ATP conducted with virtually no decay in I/R arterioles. Augmentation of conductivity was not observed in the 1-hour reperfusion groups (B and D). Moreover, I/R did not alter conducted constriction. CONCLUSIONS: Ischemia-reperfusion led to a specific augmentation of conducted vasodilation in cerebral arterioles. Presumably, enhanced conductivity may improve cerebral perfusion after ischemia.

Adenosine↗

Impact of basilar artery vasospasm on outcome in patients with severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: The purpose of the present study was to evaluate the impact of basilar artery (BA) vasospasm on outcome in patients with severe vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Sixty-five patients with clinically suspect severe cerebral vasospasm after aSAH underwent cerebral angiography before endovascular treatment. Vasospasm severity was assessed for each patient by transcranial Doppler measurements, angiography, and (99m)Tc-ethylcysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging. Percentage of BA narrowing was calculated in reference to the baseline angiogram. RESULTS: BA narrowing >or=25% was found in 23 of 65 patients, and delayed brain stem (BS) hypoperfusion, as estimated by ECD-SPECT, was found in 16. Fourteen of 23 patients with BA narrowing >or=25% experienced BS hypoperfusion, whereas only 2 of 42 patients with >or=25% BA narrowing experienced BS ischemia (P<0.001). Stepwise logistic regression after adjusting for age with Hunt and Hess grade, Fisher grade, hydrocephalus, and aneurysmal location as covariables revealed BA narrowing >or=25% and delayed BS hypoperfusion to be significantly and independently associated with unfavorable 3-month outcome (P=0.0001; odds ratio, 10.1; 95% CI, 2.5 to 40.8; and P=0.007; odds ratio, 13.8, 95% CI, 2.18 to 91.9, respectively). CONCLUSIONS: These findings suggest for the first time that BA vasospasm after aSAH is an independent and significant prognostic factor associated with poor outcome in patients with severe cerebral vasospasm requiring endovascular therapy. Further study should be done to evaluate the role of interventional therapy on outcome in patients with posterior circulation vasospasm.

Adult↗

Dynamic perfusion computed tomography in the diagnosis of cerebral vasospasm.

OBJECTIVE: The aim of the study was to correlate absolute cerebral blood flow (CBF) and mean transient time (MTT) measured by dynamic perfusion computed tomographic (PCT) scanning with the clinical course, vasospasm severity, and perfusion abnormality in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. METHODS: Forty-six patients with vasospasm after aneurysmal subarachnoid hemorrhage had 63 PCT images obtained during the course of vasospasm. All patients had transcranial Doppler measurements, 28 had an angiography study, and 38 had 99mTc single-photon emission computed tomographic imaging performed in conjunction with the PCT scan. RESULTS: The average minimal regional CBF (rCBF) and maximal regional MTT in patients with delayed ischemic deficit were significantly different in comparison with patients without delayed ischemic deficit (22.6 +/- 11.2 cm3/100 g/min versus 45.2 +/- 21.3 cm3/100 g/min, P < 0.001; 7.3 +/- 2.5 s versus 3.3 +/- 1.7 s, P < 0.05). The average minimal rCBF and maximal regional MTT in middle cerebral vascular territories in which severe middle cerebral artery vasospasm was measured by transcranial Doppler were significantly different in comparison with middle cerebral vascular territories in which no vasospasm was measured by transcranial Doppler (29.3 +/- 1.7 cm3/100 g/min versus 54.1 +/- 25.4 cm3/100 g/min, P < 0.01; 4.5 +/- 2.4 s versus 2.8 +/- 1.1 P < 0.001). The average minimal rCBF and maximal rMTT in vascular territories with estimated severe hypoperfusion on single-photon emission computed tomographic imaging were significantly different in comparison with values in vascular territories with unimpaired perfusion as estimated by single-photon emission computed tomographic imaging (18.9 +/- 6.9 cm3/100 g/min versus 54.2 +/- 23.4 cm3/100 g/min, P < 0.001, 0.001; 8.1 +/- 1.9 s versus 2.5 +/- 0.39 s, P < 0.001). CONCLUSION: The present study suggests that, in general, quantitative measurements of rCBF and regional MTT by PCT show high concordance rates with the clinical course, vasospasm severity, and hemodynamic impairments in patients with cerebral vasospasm aneurysmal subarachnoid hemorrhage.

Adult↗

Transcranial Doppler grading criteria for basilar artery vasospasm.

OBJECTIVE: Transcranial Doppler (TCD) criteria for basilar artery (BA) vasospasm are poorly defined, and grading criteria for vertebrobasilar vasospasm are unavailable. The purpose of the present study was to define TCD grading criteria for BA vasospasm on the basis of the absolute flow velocities and the intracranial to extracranial flow velocity ratios for the posterior circulation, and to improve the sensitivity and specificity of TCD for diagnosis of BA vasospasm. METHODS: One hundred twenty-three patients with aneurysmal subarachnoid hemorrhage underwent 144 cerebral arteriograms with views of the BA during the acute phase of vasospasm (Days 3-14 after hemorrhage). BA diameters were measured and compared with diameters obtained from baseline arteriograms. Both BA and extracranial vertebral artery flow velocities were measured by TCD within 4 hours before the arteriogram. RESULTS: The velocity ratio between the BA and the extracranial vertebral arteries (VA) strongly correlated with the degree of BA narrowing (r2 = 0.648; P < 0.0001). A ratio higher than 2.0 was associated with 73% sensitivity and 80% specificity for BA vasospasm. A ratio higher than 2.5 with BA velocity greater than 85 cm/s was associated with 86% sensitivity and 97% specificity for BA narrowing of more than 25%. A BA/VA ratio higher than 3.0 with BA velocities higher than 85 cm/s was associated with 92% sensitivity and 97% specificity for BA narrowing of more than 50%. CONCLUSION: The BA/VA ratio improves the sensitivity and specificity of TCD detection of BA vasospasm. On the basis of the BA/VA ratio and BA mean velocities, we suggest new TCD grading criteria for BA vasospasm.

Adult↗

Dynamic perfusion computerized tomography in cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a comparison with technetium-99m-labeled ethyl cysteinate dimer-single-photon emission computerized tomography.

OBJECT: The aim of this study was to correlate cerebral blood flow (CBF) and mean transient time (MTT) measured on dynamic perfusion computerized tomography (CT) with CBF using (99m)Tc ethyl cysteinate dimer-single-photon emission computerized tomography (SPECT) in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). METHODS: Thirty-five patients with vasospasm following aneurysmal SAH (12 men and 23 women with a mean age of 49.3 +/- 10.1 years) underwent imaging studies; thus, 35 perfusion CT scans and 35 SPECT images were available for comparison. The CBF and MTT values in 12 different brain regions were defined relative to the interhemispheric occipital cortex values using perfusion CT scans and were compared with qualitative relative (rel)CBF estimated on SPECT images. In brain regions with normal, mild (relCBF 71-85%), moderate (relCBF 50-70%), and severe (relCBF < 50%) hypoperfusion on SPECT, the mean relCBF values measured on perfusion CT were 1.01 +/- 0.08, 0.82 +/- 0.22, 0.6 +/- 0.15, and 0.32 +/- 0.08, respectively (p < 0.0001); the mean relMTT values were 1.04 +/- 0.14, 1.4 +/- 0.31, 2.16 +/- 0.46, and 3.3 +/- 0.54, respectively (p < 0.0001). All but one brain region (30 regions) with severe hypoperfusion on SPECT images demonstrated relCBF values less than 0.6 and relMTT values greater than 2.5 on perfusion CT scans. CONCLUSIONS: Relative CBF and MTT values on perfusion CT showed a high concordance rate with estimated relCBF on SPECT in patients with vasospasm following aneurysmal SAH. Given its logistical advantages, perfusion CT may be a valuable method of assessing perfusion abnormality in the acute setting of vasospasm and in patients with an unstable condition following aneurysmal SAH.

Adult↗

Effect of caffeine on cerebral blood flow response to somatosensory stimulation.

Despite caffeine's wide consumption and well-documented psychoactive effects, little is known regarding the effects of caffeine on neurovascular coupling. In the present study, we evaluated the effects of caffeine, an adenosine receptor antagonist, on intracerebral arterioles in vitro and subsequently, on the pial circulation in vivo during cortical activation induced by contralateral sciatic nerve stimulation (SNS). In our in vitro studies, we utilized isolated intracerebral arterioles to determine the effects of caffeine (10 or 50 micromol/L) on adenosine-induced vasodilatation. At the lower concentration, caffeine was without effect, but at the higher concentration, caffeine produced significant attenuation. In our in vivo studies, we determined the cerebrospinal fluid (CSF) caffeine concentrations at 15, 30, and 60 mins after intravenous administration of 5, 10 and 40 mg/kg. At the latter two concentrations, CSF levels exceeded 10 micromol/L. We then evaluated the pial arteriolar response during cortical activation caused by contralateral SNS after administering caffeine intravenously (0, 5, 10, 20 30, and 40 mg/kg). The pial circulation was observed through a closed cranial window in chloralose-anesthetized Sprague-Dawley rats. The contralateral sciatic nerve was isolated, positioned on silver electrodes and stimulated for 20 secs (0.20 V, 0.5 ms, and 5 Hz). Arteriolar diameter was quantified using an automated video dimension analyzer. Contralateral SNS resulted in a 23.8% +/-3.9% increase in pial arteriolar diameter in the hindlimb sensory cortex under control conditions. Intravenous administration of caffeine at the lowest dose studied (5 mg/kg) had no effect on either resting arteriolar diameter or SNS-induced vasodilatation. However, at higher doses (10, 20, 30, and 40 mg/kg, intravenously), caffeine significantly (P < 0.05; n = 6) attenuated both resting diameter and cerebral blood flow (CBF) responses to somatosensory stimulation. Intravenous administration of theophylline (10, 20, and 40 mg/kg), another adenosine receptor antagonist, also significantly reduced SNS-induced vasodilatation in a dose-dependent manner. Hypercarbic vasodilatation was unaffected by either caffeine or theophylline. The results of the present study show that caffeine significantly reduces cerebrovascular responses to both adenosine and to somatosensory stimulation and supports a role of adenosine in the regulation of CBF during functional neuronal activity.

Adenosine↗

Bromophenol blue staining of tumors in a rat glioma model.

OBJECTIVE: For patients with gliomas, decreasing the tumor burden with macroscopic surgical resection may affect quality of life, time to tumor progression, and survival. Injection of bromophenol blue (BPB) may enhance intraoperative visualization of an infiltrating tumor and its margins and improve the extent of resection. In this study, we investigated the uptake of BPB in experimental rat brain tumors. METHODS: We first conducted a toxicity study with bolus intravenous injections of 5, 60, and 360 mg/kg doses of BPB in nontumor-bearing Fischer 344 rats. No adverse effects were observed in any of the animals during the 60 day observation period. We then injected 9L tumor cells intracerebrally into Fischer 344 rats and approximately 2 weeks later, administered a bolus intravenous injection of 5 to 360 mg/kg BPB. Fifteen minutes after BPB injection, we sacrificed the animals and removed their brains. In a subsequent study, we injected 180 mg/kg BPB and sacrificed animals at several time points to monitor tumor staining over time. RESULTS: The stain was clearly visible and localized to the tumor for all BPB concentrations 60 mg/kg or greater, and in an additional experiment, we found that tumor staining persisted for at least 8 hours after BPB injection. CONCLUSION: We conclude that BPB helped visualize experimental tumors at time points from a few minutes to several hours after injection. Because BPB also proved to be nontoxic to the animals at effective concentrations, we believe the compound may be potentially useful in helping neurosurgeons visualize brain tumors in humans.

Animals↗

Basilar artery vasospasm and delayed posterior circulation ischemia after aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: The clinical and hemodynamic impacts of basilar artery (BA) vasospasm (VS) after aneurysmal subarachnoid hemorrhage (SAH) are ill-defined. The purpose of the present study was to evaluate the relationship between BA-VS and regional cerebral blood flow (rCBF) with posterior circulation after aneurysmal SAH. METHODS: Daily transcranial Doppler (TCD) measurements of posterior and anterior circulation arteries were conducted in 162 patients with aneurysmal SAH. rCBF to the brain stem (BS) and other brain territories was assessed by multiple single-photon emission computed tomography with (99m)Tc ethyl cysteinate dimer single-photon emission computed tomography (ECD-SPECT) imaging during the course of VS. RESULTS: SPECT imaging showed delayed BS hypoperfusion in 29 patients (17.9%). Of them, 23 patients (79.3%) were found to have BA-VS. Patients with very high BA flow velocities (FVs; >115 cm/s) had a 50% chance of developing delayed BS ischemia. BA-VS was found at a higher rate in patients who experienced reduced rCBF in the cerebellum (56.3%), thalamic nuclei (68.4%), and occipital lobe (81.8%). Although patients with delayed BS hypoperfusion did not present with a higher clinical grade, their clinical outcome was significantly worse (Glasgow Outcome Score after 30 days 2.48+/-1.16 versus 3.3+/-1.27; P=0.001). CONCLUSIONS: These findings suggest for the first time that BA-VS after aneurysmal SAH is associated with hypoperfusion to BS and other posterior circulation territories. The risk for delayed BS ischemia increased significantly when TCD BA-FVs were >115 cm/s.

Adult↗

Impact of surgical clipping on survival in unruptured and ruptured cerebral aneurysms: a population-based study.

BACKGROUND AND PURPOSE: The management of aneurysms is controversial because little is known about the impact of clipping on long-term outcome. This study was designed to evaluate long-term survival of patients with aneurysms undergoing clipping in a statewide population. METHODS: We used a retrospective design using an administrative database to identify patients hospitalized with aneurysms (1987 to 2001). Time-to-event analysis was used to determine the risk of death from all causes and from neurological causes. RESULTS: 4619 patients (mean age 54.7+/-15.3, 66.3% female) were hospitalized with cerebral aneurysms. Survival among patients with ruptures was significantly lower compared with patients with unruptured aneurysm (P<0.001) with adjusted hazard ratio (HR) of death after clipping 40% higher (HR: 1.4; 95% CI: 1.2, 1.7) in patients with rupture compared with those that were unruptured. Survival estimates for unruptured patients who underwent clipping were significantly higher than among those unruptured patients who did not undergo clipping (P<0.001), with adjusted HR of death 30% higher in patients with unruptured aneurysm that were not clipped compared with unruptured patients who were clipped (HR: 1.3; 95% CI: 1.1, 1.6). Patients with unruptured aneurysm who underwent clipping and survived beyond the 30-day postoperative period were less likely to die from neurologically related causes (5.6 versus 2.3%, P<0.001). Patients with ruptures and aneurysms who underwent clipping have a higher rate of death compared with the general population in the long-term. CONCLUSIONS: Short-term and long-term mortality after clipping of cerebral aneurysms is higher than previously reported. Patients with unruptured aneurysms who undergo clipping have improved survival compared with those who do not undergo clipping. This study supports the use of early intervention in the management of patients with unruptured aneurysms.

Aneurysm, Ruptured↗

Accurate intraoperative localization of spinal dural arteriovenous fistulae with embolization coil: technical note.

Spinal dural arteriovenous fistulae represent a potentially curable cause of a progressive myelopathy and therefore should be treated aggressively by either endovascular or surgical methods. In the surgical treatment of these lesions, intraoperative radiographic localization of the site of the fistula can be problematic. We describe an endovascular technique in which radiopaque microcoils are placed in the major feeding artery(ies) after completion of spinal angiography, which then provides a marker that is easily visualized with intraoperative x-rays, allowing effective localization of the site of the fistula.

Angioplasty↗

The utility of magnetic resonance imaging in evaluating peripheral nerve disorders.

The evaluation of peripheral nerve injuries has traditionally relied primarily on information gained from the clinical history, physical examination, and electrodiagnostic testing. Taken together, all of this clinical and diagnostic information often allows one to determine the location and severity of the underlying peripheral nerve problem. However, it may not be sufficient in diagnosing a focal entrapment neuropathy superimposed upon a more generalized peripheral neuropathy; localizing a focal lesion along a long segment of nerve which may be difficult to assess accurately with electrodiagnostic studies; distinguishing early between an axonotmetic grade of injury, which can recover through axonal regeneration, and a neurotmetic grade which cannot and therefore may benefit from a surgical exploration and repair procedure; and noninvasively diagnosing and determining the surgical resectability of peripheral nerve mass lesions such as tumors. The goal of this review is to illustrate how standard and evolving magnetic resonance imaging techniques can provide additional information in dealing with some of these problems.

Humans↗

Intracarotid RMP-7 enhanced indocyanine green staining of tumors in a rat glioma model.

OBJECTIVE: The extent of resection in patients with primary brain tumors may affect the quality of life, time to tumor progression, and survival. Currently, the extent of resection during surgery is guided by the visual appearance and consistency of tumor, frozen sections of the margins, intraoperative ultrasound, and frameless navigational systems and intraoperative imaging modalities. A new method that enhances the visualization of an infiltrating tumor and its margins may further aid in obtaining a more complete resection. A study was thus undertaken to assess the staining of brain tumors using Indocyanine green (ICG), a water-soluble emerald green tricarbocynanine dye concomitantly with RMP-7, a bradykinin analog, that selectively increases vascular permeability in brain tumors. METHODS: A syngeneic ethyl-nitrosourea-induced F-344 rat cell line (36B-10) was stereotactically implanted into 25 rats, and allowed to mature for 15-18 days. Intracarotid administration of 0.75 ml of RMP-7 at a standard dose of 0.4 microg/ml over 15 min was then infused. Varying doses of ICG (range, 0-60 mg/kg) were then injected 15 min after the RMP-7 infusion ended. The animals were sacrificed 15 min after the ICG infusion was completed, and the brains examined macroscopically and microscopically for evidence of tumor staining. RESULTS: This study demonstrated consistent staining of the tumor at only slightly lower ICG doses than previously described, however uptake at the tumor margins was evident at much lower doses. Thus the combination of ICG and RMP-7 administered preoperatively may provide visual enhancement of an infiltrating tumor and its margins to help facilitate a radical tumor removal.

Animals↗