Caspase 3和Caspase 8与蛛网膜下腔出血后脑血管痉挛的关系
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摘要
目的:建立兔蛛网膜下腔出血脑血管痉挛模型,探讨半胱氨酸天冬氨酸特异性酶切蛋白酶3、8(Caspase 3、8)在蛛网膜下腔出血后不同时间点基底动脉的表达情况及其与脑血管痉挛的关系。
     方法:1、新西兰大白兔36只,随机分为对照组(n=6)和SAH组(n=30),SAH组再按时间随机分为1、3、5、7、10天5个小组,每个时相点各6只,采用枕大池二次注血的方法建立SAH模型。另取4只兔子备行透射电镜检查,2只对照组,2只实验组(术后第7天)。二次注血后在各时间点采用灌流固定法处死动物,留取基底动脉标本。用光学显微镜观察基底动脉形态学改变,测定横截面积判断有无血管痉挛;用透射电镜观察基底动脉超微结构的形态学改变;
     2、应用TUNEL法显示血管内皮细胞及平滑肌细胞的凋亡情况,免疫组化方法显示Caspase 3、8在基底动脉中的表达情况。
     结果:1、实验组与对照组相比,血管壁增厚、内皮皱缩,血管内径和管腔面积明显减少,形态学改变符合脑血管痉挛改变。实验组基底动脉横截面积总体小于对照组,与对照组比较差异显著(P<0.05);透射电镜观察到实验组血管部分内皮细胞脱落,紧密联接打开,内皮间隙扩大;内弹力膜扭曲、不连续;平滑肌细胞变形,胞浆空泡化;而对照组内皮细胞连续,细胞间可见紧密连接,胞质内结构无异常。
     2、TUNEL法观察到凋亡细胞在实验组第1d出现,第7d凋亡水平达到最高,对照组少见凋亡细胞。免疫组化显示Caspase 3、8在实验组内皮细胞中有大量的表达,与对照组比较有显著性差异(P<0.05)。Caspase3、8在SAH后第1d出现,第3d较第1d增多,第5d和第7d出现强烈表达,第l0 d表达明显减弱。
     结论:1、采用新西兰大白兔枕大池二次注血法建立SAH后CVS模型是稳定可靠的,能够较好地模拟人类SAH后CVS。
     2、在兔脑血管痉挛模型的基底动脉中存在细胞凋亡,Caspase 3、8的表达明显增加,具有一定的时间规律性。Caspase 3、8参与了基底动脉内皮细胞凋亡的过程和蛛网膜下腔出血后脑血管痉挛的发生。
Objectives:To establish the model of cerebral vasospasm after subarachnoid hemorrhage in rabbits and to study the expression of Caspase 3、8 in the basilar artery after subarachnoid hemorrhage at various time point and the relationship between Caspase 3、8 and cerebral vasospasm .
     Methods: 1、Thirty six New Zealand rabbits were randomized into 2 groups: control group(n=6) and SAH group (n=30).Then the latter group was randomly divided into 5 groups according to the time:1d,3d,5d,7d,10d (6 per group) . Models of SAH were successfully induced via injecting autologous blood into the cisterna magna twice.Another 4 rabbits were used for the examination of the transmission electron microscope:2 control group and 2 SAH group(D7).The perfusion-fixation was performed for sacrifice of the rabbits in different time after the second blood injection in vivo and the basilar arteries were taken.The morphological changes of the basilar artery were observed under optical microscope and the lumen areas were measured to assess vasospasm in all groups and the ultrastructural changes of BA afte SAH were examined by TEM.
     2、Immunohistochemistry technique and TUNEL were used to observe the expression of Caspase3、8 and the apoptosis in the basilar artery.
     Results: 1、Compared with the control group, the basilar arteries in experimental groups demonstrate vascular walls thickening、endothelial cells shrinking, diameters and lumen areas significantly decreasing and the morphological changes according with cerebral vasospasm change.The basilar artery lumen areas were smaller in control group than those in SAH groups and the results were statistically significant(P<0.05). The TEM shows part of the vascular endothelial cells falling off , tight junction opening, endothelial cells gap increasing, the inside elastic membrane distorting and breaking, smooth muscle cells deformation,cytoplasm vacuole changing in experimental groups, while in the control group it reveals the vascular endothelial cells in succession, tight junction undamaged, the structure of the cytoplasm in good condition.
     2、Apoptosis cells were seen in the SAH groups through TUNEL and they appeared in day 1, reaching the highest in day 7,however,they were rare seen in the control group.There were statistically significant difference about the expression of Caspase3 and Caspase 8 in the basilar arteries between the control group and SAH groups (P<0.05). The expression of Caspase3 and Caspase8 in the basilar arteries appeared in day 1 and augmented in day 3,reaching the highest in day 5 and day 7 and decreasing apparently in day 10 .
     Conclusion:1、The New Zealand rabbits models that were established by injecting autologous blood into the cisterna magna twice are practical,and are reliable for experimental studies of vasospasm after subarachnoid hemorrhage in human .
     2、There is apoptosis in the basilar arteries of rabbits from cerebral vasospasm models.The expression of Caspase 3 and Caspase 8 increases apparently and have a certain time regularity . Caspase 3 and Caspase8 play roles in the process of apoptosis of endothelial cells in the basilar artery and in the occurrence of cerebral vasospasm after subarachnoid hemorrhage.
引文
[1]Pobereskin LH.Incidence and outcome of subarachnoid hemorrhage:a retrospective population based study [J].Neurol Neurosurg Psychiatry. 2001,70(3):340-343.
    [2]梁琦,宋锦宁.蛛网膜下腔出血致脑血管痉挛的机制和临床治疗进展[J].国际脑血管病杂志,2006,14(6):441-444.
    [3] Loch Macdonald R.Management of cerebral vasospasm[J].Neurosurg Rev,2006,29(3):179—193.
    [4]Vatter H,Weidauer S,Konczalla J,et a1.Time course in the development of cerebral vasospasm after experimental subarachnoid hemorrhage:clinical and neuroradiological assessment of the rat double hemorrhage model[J].Neurosurgery,2006,58(6):1190-1197.
    [5]Akin E,Clower B,Tibbs R,et al.Bilirubin produces apoptosis in cultured bovine brain endothelial cells[J].Brain Res, 2002,931(2):168-175.
    [6]林志国,刘恩生,戴钦舜.脑血管痉挛动物模型的制作[J].国外医学脑血管疾病分册,1997,5:10-13.
    [7]Otsuji T,Endo S,Hirashima Y,et a1.An experimental model of symptomatic vasospasm induced by oxyhemoglobin in rabbffs[J].Stroke,1994;25(3):657—662.
    [8]Megyesi JF,Vollrath B,Cook DA,et a1.In vivo animal models of cerebral vasospasm:a review[J].Neurosurgery,2000,47(3):794—795.
    [9]Tsurutani H,Ohkuma H,Suzuki S.Effects of thrombin inhibitor on thrombin related signal transduction and cerebral vasospasm in the rabbit subarachnoid hemorrhage model[J].Stroke,2003,34 (6):l497-1500.
    [10] Hacker G.The morphology of apoptosis [J].Cell Tissue Res, 2000, 301(1):5—17.
    [11]Stewart JH 4th,Nguyen DM,Chen GA,et a1.Induction of apoptosis in malignant pleural mesothelioma cells by activation of the Fas(Apo-1/CD95)death-signal pathway [J].J Thorac Cardiovasc Surg,2002,123(2):295—302.
    [12] Li P, Nijhawan D, Budihardjo I,et al. Cytochrome c and dATP-dependent formation of Apaf-1/caspase-9 complex initiates an apoptotic protease cascade[J]. Cell,1997,91(4):479—89.
    [13]Meguro T,Chen B,Lancon J,et a1.Oxyhemoglobin induces caspase mediated cell death in cerebral endothelial cells [J].J Neurochem,2001,77(4):1128—1135.
    [14]Martin LJ. Neuronal cell death in nervous system development,disease, and injury (Review)[J].Int J Mol Med ,2001,7(5): 455–478.
    [15] Marani M,TenevT,HancockD,et a1.Identification of novel isoforms of the BH3 domain protein Bim which directly activate Bax to trigger apoptosis [J].Mol Ceil Biol,2002,22(11):3577—3589.
    [16]Ferrer I,Planas AM.Signaling of cell death and cell survival following focal cerebral ischemia: life and death struggle in the penumbra [J].J Neuropathol Exp Neurol,2003,62(4):329–339.
    [17] Zubkov AY,Ogihara K,Bernanke DH,et a1.Apoptosis of endothelial cells in vessels affected by cerebral vasospasm[J].Surg Neurol,2000 53(3): 260—266.
    [18] Zubkov AY,Tibbs RE,Clower B,et a1.Apoptosis in basilar endothelial cells in canine double hemorrhage model[J].Acta Neurochir,2001,77:29—31.
    [19] Zhou C,Yamaguchi M,Kusaka G,et a1.Caspase inhibitors prevent endothelial apoptosis and cerebral vasospasm in dog model of experimental subarachnoid hemorrhage [J].J Cereb Blood Flow Metab,2004,24(4):4l9—431.
    [20]Iuliano BA,Pluta RM,Jung C,et a1.Endothelial dysfunction in a primate model of cerebral vasospasm[J].J Neurosurg,2004,100:287—294.
    [21]茅磊,史继新,张鑫,等.半胱氨酸蛋白酶-3抑制剂对蛛网膜下腔出血后脑血管痉挛的作用[J].中国微侵袭神经外科杂志,2006,11(5):225—227.
    [22] Aoki K,Zubkov AY,Ross IB,et a1.Therapeutic effect of caspase inhibitors in the prevention of apoptosis and reversal of chronic cerebral vasospasm[J].J Clin Neurosci,2002,9(6):672—677.
    [23]Park S,Yamaguchi M,Zhou C,et al.Neurovascular protection reduces early brain injury after subarachnoid hemorrhage[J].Stroke,2004,35 (10):2412—2417.
    [24] Cahill J,Calvert JW,Zheng JH.Mechanisms of early brain injury after subarachnoid hemorrhage[J].J Cereb Blood Flow Metab,2006,26(11):134l—1353.
    [25]Kusaka G,Ishikawa M,Nanda A et a1.Signaling pathways for early brain injury after subarachnoid hemorrhage[J]. J Cereb Blood FlOW Metab, 2004, 24(8):916-925.
    [26]Broderick JP,Brott TG,Duldner JE,et a1.Initial and recurrent bleedang are the major causes of death following subarachnoid hemorrhage [J].Stroke,1994,25(7):1342-1347.
    [27]Sabri M,Kawashima A,Ai J,et al.Neuronal and astrocytic apoptosis after subarachnoid hemorrhage: a possible cause for poor prognosis [J] . Brain Res, 2008, 1238: 163—171.
    [28]Frykholm P, Andersson JL,Langstorm B,et al.Haemodynamic and metabolic disturbances in the acute stage of subarachnoid haemorrhage demonstrated by PET [J].Acta Neurol Scand,2004,109(1):25—32.
    [29]Chen D,Chen JJ,Yin Q,et al.Role of ERK1/2 and vascular cell proliferation in cerebral vasospasm after experimental subarachnoid hemorrhage[J]. Acta Neurochir (Wien),2009 ,151(9):1127—34.
    [30]Ducruet AF, Gigante PR, Hickman ZL,et a1.Genetic determinants of cerebral vasospasm delayed cerebral ischemia, and outcome after aneurysmal subarachnoid hemorrhage [J].J Cereb Blood Flow Metab , 2010 , 30(4): 676–688.
    [31] Cahill J,Zhang JH.Subarachnoid Hemorrhage :Is It Time for a New Direction [J]? Stroke,2009,40(3suppl):S86—87.
    [32] Gao C,Liu X,Liu W,et al.Anti-apoptotic and neuroprotective effects of Tetramethylpyrazine following subarachnoid hemorrhage in rats [J] . Auton Neurosci,2008,141(1-2):22-30.
    [1]Bederson JB, Sander CE, Hunt BH, et al.Guidelines for the management of aneurismal subarachnoid hemorrhage:A statement for healthcare professionals from a special writing group of the Stroke Council,American Heart Association [J].Stroke,2009,40(3):994-1025.
    [2]van der Bilt IA, Hasan D, Vandertop WP,et al.Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis[J].Neurology,2009,72(7):635-42.
    [3]Frontera JA, Fernandez A, Schmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition [J]? Stroke, 2009,40(6):1963-1968.
    [4]Stein SC, Browne KD,Chen XH,et al.Thromboembolism and delayed cerebral ischemia after subarachnoid hemorrhage: an autopsy study [J]. Neurosurgery,2006,59(4):781-7;discussion 787-8.
    [5]Vergouwen MD,Vermeulen M,Coert BA, et al.Microthrombosis after aneurysmal subarachnoid hemorrhage: an additional explanation for delayed cerebral ischemia [J].Cereb Blood Flow Metab,2008,28 (11): 1761 - 1770.
    [6]Romano JG,Forteza AM,Concha M,et al.Detection of microemboli by transcranial Doppler ultrasonography in aneurysmal subarachnoid hemorrhage [J]. Neurosurgery, 2002,50(5):1026-1031.
    [7]Dorhout Mees SM, van den Bergh WM, Algra A,et al. Antiplatelet therapy in aneurysmal subarachnoid hemorrhage [J].Stroke,2008,39:2186-2187.
    [8]Somjen GG.Mechanisms of spreading depression and hypoxic spreading depression-like depolarization [J].Physiol Rev,2001,81(3):1065-1096.
    [9]Nozari A,Dilekoz E,Sukhotinsky I,et al. Microemboli may link spreading depression,migraine aura,and patent foramen ovale [J]. Ann Neurol,2010,67(2): 221-229.
    [10]Leng LZ,Fink ME,Iadecola C.Spreading Depolarization :A Possible New Culprit in the Delayed Cerebral Ischemia of Subarachnoid Hemorrhage [J]. Arch Neurol,2010,[Epub ahead of print].
    [11]Shin HK,Dunn AK,Jones PB,et al.Normobaric hyperoxia improves cerebral blood flow and oxygenation,and inhibits peri-infarct depolarizations in experimental focal ischaemia [J].Brain,2007,130(Pt 6):1631-1642
    [12]del Zoppo GJ.Microvascular responses to cerebral Ischemia/ in?ammation.[J]. Ann N Y Acad Sci,1997,823:132-147.
    [13]Sarrafzadeh A,Schlenk F ,Gericke C,et al. Relevance of Cerebral Interleukin-6 After Aneurysmal Subarachnoid Hemorrhage [J]. Neurocrit Care,2010,13(3): 339– 346.
    [14]Vergouwen MD,van Geloven N,de Haan RJ,et al.Increased cortisol levels are associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage[J].Neurocrit Care 2010;12(3):342–345.
    [15] Ducruet AF, Gigante PR, Hickman ZL,et al.Genetic determinants of cerebral vasospasm,delayed cerebral ischemia, and outcome after aneurismal subarachnoid hemorrhage [J].J Cereb Blood Flow Metab, 2010, 30(4),676–688.
    [16]Farhat SM, Schneider RC.Observations on the effect of systemic blood pressure on intracranial circulation in patients with cerebrovascular insufficiency [J].J Neurosurg ,1967,27(5):441-445.
    [17]Frontera JA, Fernandez A, Schmidt JM ,et al.Clinical response to hypertensive hypervolemic therapy and outcome after subarachnoid hemorrhage [J]. Neurosurgery,2010,66(1): 35-41.
    [18]Raabe A, Beck J, Keller M,et al. Relative importance of hypertension compared with hypervolemia for increasing cerebral oxygenation in patients with cerebral vasospasm after subarachnoid hemorrhage [J].J Neurosurg,2005,103(6):974-981.
    [19]Zwienenberg-LeeM,Hartman J,Rudisill N,et al.Endovascular management of cerebral vasospasm [J]. Neurosurgery ,2006,59(5): S139-S147; discussion S3-S13.
    [20]Oran I,Cinar C.Continuous intra-arterial infusion of nimodipine during embolization of cerebral aneurysms associated with vasospasm [J] . AJNR, 2008, 29(2):291-295.
    [21] Eddleman CS, Hurley MC, Naidech AM,et al.Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm [J]. Neurosurg Focus,2009,26(3):E6.
    [22] Mesis RG, Wang H, Lombard FW ,et al.Dissociation between vasospasm and functional improvement in a murine model of subarachnoid hemorrhage [J]. Neurosurg Focus,2006,21(3):E4.
    [23]Dreier JP,Korner K,Ebert N,et al.Nitric oxide scavenging by hemoglobin or nitric oxide synthase inhibition by N-nitro-L-arginine induces cortical spreading ischemia when K+ is increased in the subarachnoid space [J].J Cereb Blood Flow Metab, 1998,18(9):978-990.
    [24]Dreier JP, Major S, Manning A, et al.Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoidhaemorrhage [J].Brain,2009,132(pt7):1866-1881.
    [25]Chou SH,Smith EE,Badjatia N,et al.A randomized, double-blind, placebo- controlled pilot study of simvastatin in aneurysmal subarachnoid hemorrhage [J]. Stroke,2008,39(10):2891-2893.
    [26]Vergouwen MD,Meijers JC,Geskus RB,et al.Biologic effects of simvastatin in patients with aneurysmal subarachnoid hemorrhage: a double-blind, placebo- controlled randomized trial [J].J Cereb Blood Flow Metab,2009,29(8):1444-1453.
    [27]Vergouwen MD, de Haan RJ, Vermeulen M,et al.Effect of statin treatment on vasospasm, delayed cerebral ischemia, and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis update [J].Stroke,2010,41(1):e47-e52.
    [28]McGirt MJ,Blessing R,Alexander MJ,et al.Risk of cerebral vasospasm after subarachnoid hemorrhage reduced by statin therapy: a multivariate analysis of an institutional experience [J].J Neurosurg, 2006,105 (5): 671-674.
    [29]Moskowitz SI, Ahrens C, Provencio JJ,et al.Prehemorrhage statin use and the risk of vasospasm after aneurysmal subarachnoid hemorrhage [J]. Surg Neurol, 2009, 71(3):311-317,discussion 317-318.
    [30]Sandercock P.'Yes' or 'no' to routine statins after subarachnoid hemorrhage to prevent delayed cerebral ischaemia, vasospasm, and death? A cautionary tale of 2 meta-analyses [J].Stroke,2010,41(1):e1-2.
    [31]van den Bergh WM, Algra A, van der Sprenkel JW, et al .Hypomagnesemia after aneurysmal subarachnoid hemorrhage [J]. Neurosurgery, 2003, 52(2): 276-281; discussion 81-82.
    [32]Stippler M, Crago E, Levy EI, et al. Magnesium infusion for vasospasm prophylaxis after subarachnoid haemorrhage [J].JNeurosurg, 2006, 105(5): 723–729.
    [33] MA L,LIU WG,ZHANG JM,et al.Magnesium sulphate in the management of patients with aneurysmal subarachnoid haemorrhage: A meta-analysis of prospective controlled trials [J]. Brain Inj,2010,24(5):730–735.
    [34] Kasuya H,Onda H, Sasahara A,et al.Application of nicardipine prolonged-release implants: analysis of 97 consecutive patients with acute subarachnoid hemorrhage [J].Neurosurgery,2005,56(5):895-902; discussion 895-902.
    [35]Laskowitz DT,Kolls BJ.Neuroprotection in Subarachnoid Hemorrhage [J]. Stroke, 2010,41(10),S79-S84.
    [36]Wang H,Gao J,Lassiter TF, et al.Levetiracetam is neuroprotective in murine models of closed head injury and subarachnoid hemorrhage [J]. Neurocrit Care, 2006, 5(1):71–78.
    [37]Munakata A, Ohkuma H,Nakano T,et al.Effect of a free radical scavenger, edaravone,in the treatment of patients with aneurysmal subarachnoid hemorrhage [J]. Neurosurgery,2009,64(3):423–428.
    [38]Kasius KM, Frijns CJ,Algra A,et al.Association of Platelet and Leukocyte Counts with Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage [J].Cerebrovasc Dis,2010,29(6):576–583.
    [39]Claassen J, Bernardini GL, Kreiter K ,et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage:the Fisher scale revisited [J]. Stroke,2001,32(9):2012-2020.

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