触珠蛋白减轻绵羊脑脊液血红蛋白诱导的神经功能恶化。

Haptoglobin Attenuates Cerebrospinal Fluid Hemoglobin-Induced Neurological Deterioration in Sheep.

作者信息

Thomson Bart R, Schwendinger Nina, Beckmann Katrin, Gentinetta Thomas, Couto Daniel, Wymann Sandra, Verdon Valérie, Buzzi Raphael M, Akeret Kevin, Kronen Peter W, Weinberger Eva M, Held Ulrike, Seehusen Frauke, Richter Henning, Schaer Dominik J, Hugelshofer Michael

机构信息

Department of Neurosurgery, Clinical Neuroscience Center, Universitätsspital and University of Zurich, Zurich, Switzerland.

Division of Internal Medicine, Universitätsspital and University of Zurich, Zurich, Switzerland.

出版信息

Transl Stroke Res. 2025 Jun;16(3):728-732. doi: 10.1007/s12975-024-01254-9. Epub 2024 Apr 23.

Abstract

Secondary brain injury (SBI) occurs with a lag of several days post-bleeding in patients with aneurysmal subarachnoid hemorrhage (aSAH) and is a strong contributor to mortality and long-term morbidity. aSAH-SBI coincides with cell-free hemoglobin (Hb) release into the cerebrospinal fluid. This temporal association and convincing pathophysiological concepts suggest that CSF-Hb could be a targetable trigger of SBI. However, sparse experimental evidence for Hb's neurotoxicity in vivo defines a significant research gap for clinical translation. We modeled the CSF-Hb exposure observed in aSAH patients in conscious sheep, which allowed us to assess neurological functions in a gyrencephalic species. Twelve animals were randomly assigned for 3-day bi-daily intracerebroventricular (ICV) injections of either Hb or Hb combined with the high-affinity Hb scavenger protein haptoglobin (Hb-Hp, CSL888). Repeated CSF sampling confirmed clinically relevant CSF-Hb concentrations. This prolonged CSF-Hb exposure over 3 days resulted in disturbed movement activity, reduced food intake, and impaired observational neuroscores. The Hb-induced neurotoxic effects were significantly attenuated when Hb was administered with equimolar haptoglobin. Preterminal magnetic resonance imaging (MRI) showed no CSF-Hb-specific structural brain alterations. In both groups, histology demonstrated an inflammatory response and revealed enhanced perivascular histiocytic infiltrates in the Hb-Hp group, indicative of adaptive mechanisms. Heme exposure in CSF and iron deposition in the brain were comparable, suggesting comparable clearance efficiency of Hb and Hb-haptoglobin complexes from the intracranial compartment. We identified a neurological phenotype of CSF-Hb toxicity in conscious sheep, which is rather due to neurovascular dysfunction than structural brain injury. Haptoglobin was effective at attenuating CSF-Hb-induced neurological deterioration, supporting its therapeutic potential.

摘要

继发性脑损伤(SBI)在动脉瘤性蛛网膜下腔出血(aSAH)患者出血后数天出现,是导致死亡率和长期致残率的重要因素。aSAH-SBI与无细胞血红蛋白(Hb)释放到脑脊液中同时发生。这种时间上的关联以及令人信服的病理生理概念表明,脑脊液Hb可能是SBI的一个可靶向触发因素。然而,关于Hb在体内神经毒性的实验证据稀少,这为临床转化定义了一个重大的研究空白。我们在清醒的绵羊身上模拟了aSAH患者中观察到的脑脊液Hb暴露情况,这使我们能够在脑回动物中评估神经功能。12只动物被随机分配,每两天进行一次为期3天的脑室内(ICV)注射,注射物为Hb或Hb与高亲和力Hb清除蛋白触珠蛋白(Hb-Hp,CSL888)的组合。重复的脑脊液采样证实了具有临床相关性的脑脊液Hb浓度。这种持续3天的脑脊液Hb暴露导致运动活动紊乱、食物摄入量减少以及观察神经评分受损。当Hb与等摩尔的触珠蛋白一起给药时,Hb诱导的神经毒性作用明显减弱。临终前磁共振成像(MRI)显示没有脑脊液Hb特异性的脑结构改变。在两组中,组织学均显示出炎症反应,并在Hb-Hp组中发现血管周围组织细胞浸润增强,表明存在适应性机制。脑脊液中的血红素暴露和脑中的铁沉积相当,表明Hb和Hb-触珠蛋白复合物从颅内腔室的清除效率相当。我们在清醒的绵羊中确定了脑脊液Hb毒性的神经表型,这相当于是由于神经血管功能障碍而非脑结构损伤所致。触珠蛋白在减轻脑脊液Hb诱导的神经功能恶化方面有效,支持了其治疗潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f46a/12045829/0b7d533e38c2/12975_2024_1254_Fig1_HTML.jpg

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