Elucidation of the Mechanisms By Which Anesthetics Induce Blood-Brain Barrier Breakdown and Delirium in the Elderly

Delirium is a highly prevalent neuropsychiatric or neurocognitive disorder that presents a major problem to modern healthcare. Patients suffering from delirium normally have a worse prognosis, prolonged hospital stay, increased hospital cost, long-term cognitive impairment, and higher mortality rates. Many factors can predispose one to develop delirium, which makes treating this disorder a daunting task. Unfortunately, delirium is the most common psychiatric syndrome found in the hospital setting. In fact, a form of delirium known as postoperative delirium (POD) is one of the most common postoperative complications faced by elderly patients undergoing surgery. POD is a major problem in modern healthcare, and it will only become worse because the world’s older population (65+) is projected to triple between 2009 and 2050. This realization caused POD to emerge as an area of research interest. Many precipitating factors can cause one to develop POD, including exposure to anesthetics. Studies have indicated that many patients who were given general anesthesia have developed delirium; however, no studies have explained the mechanism by which anesthesia induces POD in patients. Unraveling this mechanism is the main goal of the research being presented here. Our lab has hypothesized that POD is caused by a temporary, anesthesia- or drug-induced breakdown of the blood-brain barrier (BBB). The BBB, which is formed by the vascular endothelium in the brain, is a highly selective barrier that separates the circulating blood from the brain and prevents a large number of substances from entering the brain. We believe that BBB breakdown after exposure to anesthetics allows an influx of plasma components into the brain tissue that disrupts brain homeostasis and causes neuronal misfiring. In the short-term, this culminates into the array of symptoms that hallmark POD. In the long-term, if not reversed or only partially reversed, this could trigger subsequent Postoperative Cognitive Decline (POCD) and Dementia. A preliminary anesthesia study conducted in our lab revealed that exposure to the inhalation anesthetics (IAs) Sevoflurane and Isoflurane causes immediate structural changes in brain vascular endothelial cells (BVECs), including an overall flattening of surface membranes and loss of the tight junction ridge. These structural changes can lead to the formation of holes in the vascular endothelial lining. This study also revealed that exposure to Sevoflurane leads to an increase in BBB permeability. A subsequent study revealed that Sevoflurane increases BBB permeability in preadolescent and elderly rats, age-dependent changes occur in the luminal surface topography of brain vascular endothelial cells associated with development and maintenance of the BBB, and Sevoflurane and Isoflurane induce changes in BVEC luminal surface topography that may be linked to increased BBB permeability. In vitro experiments using a human brain endothelial cell line (hCMEC/D3) that can form a BBB-like barrier yielded the following results: (1) hCMEC/D3 cells express tight junction proteins, (2) transendothelial electrical resistance (TEER) decreases and barrier permeability increases after hCMEC/D3 cells are exposed to anesthesia, (3) the distribution and expression of the tight junction protein ZO-1 in hCMEC/D3 cells is not affected by exposure to anesthesia, (4) addition of DMSO or floating cells to the cell culture medium does not aid the transfer of anesthetics from the air to the cell monolayer, and (5) Histamine and Acetaminophen induce contraction in hCMEC/D3 cells, which can compromise barrier functional integrity. Finally, studies on the effects of the specialized pro-resolving lipid mediator (SPM) Lipoxin in resolving BBB insults revealed the following: (1) bacterial lipopolysaccharide (LPS) injections led to an increase in BBB permeability, as evidenced by detecting IgG, a serum component normally restricted to blood vessels, in rat brain tissue. (2) Lipoxin reduces LPS-induced BBB permeability, as evidenced by decreased levels of IgG in rat brain tissue. (3) LPS induces a number of luminal surface changes in rat BVECs, as shown by scanning electron microscopy. (4) Lipoxin helps restore key luminal surface features of rat BVECs to near normal, and most importantly, blocks the death of BVECs and the associated loss of barrier integrity

Evidence That Brain-Reactive Autoantibodies Contribute to Chronic Neuronal Internalization of Exogenous Amyloid-β1-42 and Key Cell Surface Proteins During Alzheimer\u27s Disease Pathogenesis

Blood-brain barrier (BBB) permeability is a recognized early feature of Alzheimer\u27s disease (AD). In the present study, we examined consequences of increased BBB permeability on the development of AD-related pathology by tracking selected leaked plasma components and their interactions with neurons in vivo and in vitro. Histological sections of cortical regions of postmortem AD brains were immunostained to determine the distribution of amyloid-β1-42 (Aβ42), cathepsin D, IgG, GluR2/3, and alpha7 nicotinic acetylcholine receptor (α7nAChR). Results revealed that chronic IgG binding to pyramidal neurons coincided with internalization of Aβ42, IgG, GluR2/3, and α7nAChR as well as lysosomal compartment expansion in these cells in regions of AD pathology. To test possible mechanistic interrelationships of these phenomena, we exposed differentiated SH-SY5Y neuroblastoma cells to exogenous, soluble Aβ42 peptide and serum from AD and control subjects. The rate and extent of Aβ42 internalization in these cells was enhanced by serum containing neuron-binding IgG autoantibodies. This was confirmed by treating cells with individual antibodies specific for α7nAChR, purified IgG from AD or non-AD sera, and sera devoid of IgG, in the presence of 100 nM Aβ42. Initial co-localization of IgG, α7nAChR, and Aβ42 was temporally and spatially linked to early endosomes (Rab11) and later to lysosomes (LAMP-1). Aβ42 internalization was attenuated by treatment with monovalent F(ab) antibody fragments generated from purified IgG from AD serum and then rescued by coupling F(ab) fragments with divalent human anti-Fab. Overall, results suggest that cross-linking of neuron-binding autoantibodies targeting cell surface proteins can accelerate intraneuronal Aβ42 deposition in AD

Harnessing neurovascular interaction to guide axon growth

Abstract Regulating the intrinsic interactions between blood vessels and nerve cells has the potential to enhance repair and regeneration of the central nervous system. Here, we evaluate the efficacy of aligned microvessels to induce and control directional axon growth from neural progenitor cells in vitro and host axons in a rat spinal cord injury model. Interstitial fluid flow aligned microvessels generated from co-cultures of cerebral-derived endothelial cells and pericytes in a three-dimensional scaffold. The endothelial barrier function was evaluated by immunostaining for tight junction proteins and quantifying the permeability coefficient (~10−7 cm/s). Addition of neural progenitor cells to the co-culture resulted in the extension of Tuj-positive axons in the direction of the microvessels. To validate these findings in vivo, scaffolds were transplanted into an acute spinal cord hemisection injury with microvessels aligned with the rostral-caudal direction. At three weeks post-surgery, sagittal sections indicated close alignment between the host axons and the transplanted microvessels. Overall, this work demonstrates the efficacy of exploiting neurovascular interaction to direct axon growth in the injured spinal cord and the potential to use this strategy to facilitate central nervous system regeneration

Sevoflurane and Isoflurane induce structural changes in brain vascular endothelial cells and increase Blood-brain barrier permeability: Possible link to postoperative delirium and cognitive decline

A large percentage of patients subjected to general anesthesia at 65 years and older exhibit postoperative delirium (POD). Here, we test the hypothesis that inhaled anesthetics (IAs), such as Sevoflurane and Isoflurane, act directly on brain vascular endothelial cells (BVECs) to increase blood-brain barrier (BBB) permeability, thereby contributing to POD. Rats of young (3–5 months), middle (10–12 months) and old (17–19 months) ages were anesthetized with Sevoflurane or Isoflurane for 3 h. After exposure, some were euthanized immediately; others were allowed to recover for 24 h before sacrifice. Immunohistochemistry was employed to monitor the extent of BBB breach, and scanning electron microscopy (SEM) was used to examine changes in the luminal surfaces of BVECs. Quantitative immunohistochemistry revealed increased BBB permeability in older animals treated with Sevoflurane, but not Isoflurane. Extravasated immunoglobulin G showed selective affinity for pyramidal neurons. SEM demonstrated marked flattening of the luminal surfaces of BVECs in anesthetic-treated rats. Results suggest an aging-linked BBB compromise resulting from exposure to Sevoflurane. Changes in the luminal surface topology of BVECs indicate a direct effect on the plasma membrane, which may weaken or disrupt their BBB-associated tight junctions. Disruption of brain homeostasis due to plasma influx into the brain parenchyma and binding of plasma components (e.g., immunoglobulins) to neurons may contribute to POD. We propose that, in the elderly, exposure to some IAs can cause BBB compromise that disrupts brain homeostasis, perturbs neuronal function and thereby contributes to POD. If unresolved, this may progress to postoperative cognitive decline and later dementia

What's in a Name? Patterns, Trends, and Suggestions for Defining Non-Perennial Rivers and Streams.

Rivers that cease to flow are globally prevalent. Although many epithets have been used for these rivers, a consensus on terminology has not yet been reached. Doing so would facilitate a marked increase in interdisciplinary interest as well as critical need for clear regulations. Here we reviewed literature from Web of Science database searches of 12 epithets to learn (Objective 1-O1) if epithet topics are consistent across Web of Science categories using latent Dirichlet allocation topic modeling. We also analyzed publication rates and topics over time to (O2) assess changes in epithet use. We compiled literature definitions to (O3) identify how epithets have been delineated and, lastly, suggest universal terms and definitions. We found a lack of consensus in epithet use between and among various fields. We also found that epithet usage has changed over time, as research focus has shifted from description to modeling. We conclude that multiple epithets are redundant. We offer specific definitions for three epithets (non-perennial, intermittent, and ephemeral) to guide consensus on epithet use. Limiting the number of epithets used in non-perennial river research can facilitate more effective communication among research fields and provide clear guidelines for writing regulatory documents

What's in a Name? Patterns, Trends, and Suggestions for Defining Non-Perennial Rivers and Streams.

Rivers that cease to flow are globally prevalent. Although many epithets have been used for these rivers, a consensus on terminology has not yet been reached. Doing so would facilitate a marked increase in interdisciplinary interest as well as critical need for clear regulations. Here we reviewed literature from Web of Science database searches of 12 epithets to learn (Objective 1-O1) if epithet topics are consistent across Web of Science categories using latent Dirichlet allocation topic modeling. We also analyzed publication rates and topics over time to (O2) assess changes in epithet use. We compiled literature definitions to (O3) identify how epithets have been delineated and, lastly, suggest universal terms and definitions. We found a lack of consensus in epithet use between and among various fields. We also found that epithet usage has changed over time, as research focus has shifted from description to modeling. We conclude that multiple epithets are redundant. We offer specific definitions for three epithets (non-perennial, intermittent, and ephemeral) to guide consensus on epithet use. Limiting the number of epithets used in non-perennial river research can facilitate more effective communication among research fields and provide clear guidelines for writing regulatory documents

Zero or not? Causes and consequences of zero‐flow stream gage readings

Streamflow observations can be used to understand, predict, and contextualize hydrologic, ecological, and biogeochemical processes and conditions in streams. Stream gages are point measurements along rivers where streamflow is measured, and are often used to infer upstream watershed-scale processes. When stream gages read zero, this may indicate that the stream has fully dried; however, zero-flow readings can also be caused by a wide range of other factors. Our ability to identify whether or not a zero-flow gage reading indicates a dry fluvial system has far reaching environmental implications. Incorrect identification and interpretation by the data user can lead to hydrologic, ecological, and/or biogeochemical predictions from models and analyses. Here, we describe several causes of zero-flow gage readings: frozen surface water, flow reversals, instrument error, and natural or human-driven upstream source losses or bypass flow. For these examples, we discuss the implications of zero-flow interpretations. We also highlight additional methodss for determining flow presence, including direct observations, statistical methods, and hydrologic models, which can be applied to interpret causes of zero-flow gage readings and implications for reach- and watershed-scale dynamics. Such efforts are necessary to improve our ability to understand and predict surface flow activation, cessation, and connectivity across river networks. Developing this integrated understanding of the wide range of possible meanings of zero-flows will only attain greater importance in a more variable and changing hydrologic climate

Pervasive changes in stream intermittency across the United States

Non-perennial streams are widespread, critical to ecosystems and society, and the subject of ongoing policy debate. Prior large-scale research on stream intermittency has been based on long-term averages, generally using annually aggregated data to characterize a highly variable process. As a result, it is not well understood if, how, or why the hydrology of non-perennial streams is changing. Here, we investigate trends and drivers of three intermittency signatures that describe the duration, timing, and dry-down period of stream intermittency across the continental United States (CONUS). Half of gages exhibited a significant trend through time in at least one of the three intermittency signatures, and changes in no-flow duration were most pervasive (41% of gages). Changes in intermittency were substantial for many streams, and 7% of gages exhibited changes in annual no-flow duration exceeding 100 days during the study period. Distinct regional patterns of change were evident, with widespread drying in southern CONUS and wetting in northern CONUS. These patterns are correlated with changes in aridity, though drivers of spatiotemporal variability were diverse across the three intermittency signatures. While the no-flow timing and duration were strongly related to climate, dry-down period was most strongly related to watershed land use and physiography. Our results indicate that non-perennial conditions are increasing in prevalence over much of CONUS and binary classifications of ‘perennial’ and ‘non-perennial’ are not an accurate reflection of this change. Water management and policy should reflect the changing nature and diverse drivers of changing intermittency both today and in the future