Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Avenue, No. 3C-38, San Francisco, CA 94110, USA.
Stroke. 2012 Sep;43(9):2450-6. doi: 10.1161/STROKEAHA.112.659821. Epub 2012 Jul 12.
An increasing number of unruptured intracranial aneurysms are being detected, partly due to the increased use of brain imaging techniques. Pharmacological stabilization of aneurysms for the prevention of aneurysmal rupture could potentially be an attractive alternative approach to clipping or coiling in patients with unruptured intracranial aneurysms. We have developed a mouse model of intracranial aneurysm that recapitulates key features of intracranial aneurysms. In this model, subarachnoid hemorrhage from aneurysmal rupture causes neurological symptoms that can be easily detected by a simple neurological examination. Using this model, we tested whether anti-inflammatory agents such as tetracycline derivatives, or a selective inhibitor of matrix metalloproteinases-2 and -9 (SB-3CT), can prevent the rupture of intracranial aneurysms.
Aneurysms were induced by a combination of induced hypertension and a single injection of elastase into the cerebrospinal fluid in mice. Treatment with minocycline, doxycycline, or SB-3CT was started 6 days after aneurysm induction. Aneurysmal rupture was detected by neurological symptoms and confirmed by the presence of intracranial aneurysms with subarachnoid hemorrhage.
Minocycline and doxycycline significantly reduced rupture rates (vehicle versus doxycycline=80% versus 35%, P<0.05; vehicle versus minocycline=73% versus 24%, P<0.05) without affecting the overall incidence of aneurysms. However, SB-3CT did not affect the rupture rate (62% versus 55%, P=0.53).
Our data established the feasibility of using a mouse model of intracranial aneurysm to test pharmacological stabilization of aneurysms. Tetracycline derivatives could be potentially effective in preventing aneurysmal rupture.
由于脑成像技术的广泛应用,越来越多的未破裂颅内动脉瘤被发现。对于未破裂颅内动脉瘤患者,用药物稳定动脉瘤以预防其破裂,可能是一种替代夹闭或线圈栓塞的有吸引力的方法。我们建立了一种可重现颅内动脉瘤关键特征的颅内动脉瘤小鼠模型。在该模型中,颅内动脉瘤破裂导致的蛛网膜下腔出血可引起明显的神经症状,通过简单的神经学检查即可轻易检测到。利用该模型,我们检测了诸如四环素衍生物或基质金属蛋白酶-2 和 -9 (MMP-2/9)的选择性抑制剂等抗炎药物是否能预防颅内动脉瘤的破裂。
通过诱导高血压和单次向脑脊液中注射弹性蛋白酶联合的方法诱导颅内动脉瘤形成。在颅内动脉瘤形成后 6 天开始给予米诺环素、强力霉素或 SB-3CT 治疗。通过神经症状检测颅内动脉瘤破裂,并通过存在蛛网膜下腔出血的颅内动脉瘤予以确认。
米诺环素和强力霉素均显著降低了破裂率(对照组与强力霉素组分别为 80%比 35%,P<0.05;对照组与米诺环素组分别为 73%比 24%,P<0.05),但不影响动脉瘤的总体发生率。然而,SB-3CT 对破裂率无影响(对照组与 SB-3CT 组分别为 62%比 55%,P=0.53)。
我们的数据证实了使用颅内动脉瘤小鼠模型来测试动脉瘤药物稳定的可行性。四环素衍生物可能对预防动脉瘤破裂有效。