Measuring blood flow and pulsatility with MRI: optimisation, validation and application in cerebral small vessel disease

Cerebral small vessel disease (SVD) is the breakdown of the small blood vessels of the brain, leading to many cases of stroke and dementia. The pathophysiology of SVD is largely unknown, although several mechanisms have been suggested. One such mechanism is the role of increased blood flow pulsatility into the brain, caused by vessel stiffening, leading to damage of the microvasculature. Magnetic resonance imaging (MRI) allows us to non-invasively measure blood flow and velocity using a technique called phase contrast-MRI – traditionally used with 2D slices across the vessel(s) of interest. An advanced form of phase-contrast MRI, known as 4D flow, has emerged in recent years that allows for a volume of data to be acquired, containing velocity information in all directions. However, to keep scan times practical when collecting this amount of data, spatiotemporal resolution has to be sacrificed. The main aim of this thesis was to assess 4D flow’s capabilities, including comparing it to the more well-established 2D method in healthy volunteers, patients, and phantom experiments, so as to better understand its role in investigating SVD. Another aim was to learn more about the role of flow and pulsatility in SVD development in patients using data acquired in the longitudinal Mild Stroke Study 3 (MSS3). Firstly, I systematically reviewed studies that have assessed the human brain using 4D flow. Across 61 relevant studies, I found a general consensus for the current use of the technique in this context. I then optimised the Siemens prototype 4D flow sequence (N = 11 healthy volunteers), testing different parameters to find the combination that best balanced scan quality and duration. I then assessed the test-retest repeatability and intra-rater reliability of both 2D and 4D methods (N = 11 healthy volunteers), as well as differences between them. Following this, I performed the same 4D-2D comparison on SVD patients (N = 10). Absolute flow measurements using 4D flow were shown to have moderate repeatability and reliability, while flow pulsatility measurements showed acceptable repeatability and reliability. Furthermore, 2D arterial pulsatility was measured higher than with 4D, while 4D often measured higher flow rates than 2D. 4D flow was shown to be feasible when used on SVD patients, with no noticeable issues caused by potential patient movement. Flow data analysis from the longitudinal SVD study MSS3 showed that intracranial pulsatility is associated with cross-sectional SVD lesion volume but not longitudinal lesion growth, with stronger associations seen in the arteries of the neck compared to the venous sinuses

Investigating nucleation control in batch and flow using non-photochemical laser-induced nucleation

The practical application of non-photochemical laser-induced nucleation (NPLIN) to continuous flow was investigated. Supersaturated aqueous solutions were screened with a 5 ns pulsed laser (532 nm 44 MW cm-2) for NPLIN activity. Upon irradiation succinic acid nucleated at S20 = 4.3 and adipic acid at S20 = 2.0 – 3.0. NPLIN activity is reported for the first time in nicotinic acid (S20 = 2.6 – 3.0). No overall pattern was observed of chemical structure on NPLIN activity.From inorganic compounds similarly screened, ammonium chloride (S20 = 1.04 – 1.20) was identified as most suitable for further tests. It was shown to have an increase of NPLIN crystals with higher supersaturation from 13 at S = 1.038 to 252 at S = 1.135. A quadratic increase in number of crystals with increased laser power. The effects of NPLIN upon ammonium chloride are diminished upon filtration through a 0.2 μm poly (ether sulfone) filter, reducing the number of crystals from 350 to 10 per 70 mJ pulse (25 MW cm-2).The use of NPLIN in continuous flow was demonstrated from the first time. A S23 = 1.1 solution of aqueous ammonium chloride in flow produced crystals when irradiated by 10 pulses s-1 of a 1064 nm 6 ns laser. When the laser was stopped, crystals were no longer produced and the system returned to flowing supersaturated solution.Lab scale apparatus for continuous NPLIN experiments was developed. A design involving a re-dissolution step and loop flow was constructed for both laminar and slug-flow regimes. Nucleation of ammonium chloride (S = 1.1) was demonstrated in both systems. Repeatable NPLIN experiments were hindered by spontaneous nucleation. Spontaneous nucleation in flow was observed around areas where supersaturated solution passed from one component to another. Spontaneous nucleation was also observed upon cooling (25 to 10 °C). Filtration was observed to both suppress NPLIN and spontaneous nucleation in flow

Ultrastructure and complex polar architecture of the human pathogen Campylobacter jejuni

Campylobacter jejuni is one of the most successful food-borne human pathogens. Here we use electron cryotomography to explore the ultrastructure of C. jejuni cells in logarithmically growing cultures. This provides the first look at this pathogen in a near-native state at macromolecular resolution (~5 nm). We find a surprisingly complex polar architecture that includes ribosome exclusion zones, polyphosphate storage granules, extensive collar-shaped chemoreceptor arrays, and elaborate flagellar motors

Electron Cryotomography of Bacterial Cells

While much is already known about the basic metabolism of bacterial cells, many fundamental questions are still surprisingly unanswered, including for instance how they generate and maintain specific cell shapes, establish polarity, segregate their genomes, and divide. In order to understand these phenomena, imaging technologies are needed that bridge the resolution gap between fluorescence light microscopy and higher-resolution methods such as X-ray crystallography and NMR spectroscopy

Relationship Between Venules and Perivascular Spaces in Sporadic Small Vessel Diseases

Background and Purpose— Perivascular spaces (PVS) around venules may help drain interstitial fluid from the brain. We examined relationships between suspected venules and PVS visible on brain magnetic resonance imaging. Methods— We developed a visual venular quantification method to examine the spatial relationship between venules and PVS. We recruited patients with lacunar stroke or minor nondisabling ischemic stroke and performed brain magnetic resonance imaging and retinal imaging. We quantified venules on gradient echo or susceptibility-weighted imaging and PVS on T2-weighted magnetic resonance imaging in the centrum semiovale and then determined overlap between venules and PVS. We assessed associations between venular count and patient demographic characteristics, vascular risk factors, small vessel disease features, retinal vessels, and venous sinus pulsatility. Results— Among 67 patients (69% men, 69.0±9.8 years), only 4.6% (range, 0%–18%) of venules overlapped with PVS. Total venular count increased with total centrum semiovale PVS count in 55 patients after accounting for venule-PVS overlap (β=0.468 [95% CI, 0.187–0.750]) and transverse sinus pulsatility (β=0.547 [95% CI, 0.309–0.786]) and adjusting for age, sex, and systolic blood pressure. Conclusions— Despite increases in both visible PVS and suspected venules, we found minimal spatial overlap between them in patients with sporadic small vessel disease, suggesting that most magnetic resonance imaging-visible centrum semiovale PVS are periarteriolar rather than perivenular

THERAPEUTIC EFFECTS OF HYPOXIC AND PRO-INFLAMMATORY PRIMING OF MESENCHYMAL STEM CELL-DERIVED EXTRACELLULAR VESICLES IN INFLAMMATORY ARTHRITIS

AbstractNovel biological therapies have revolutionised the management of Rheumatoid Arthritis (RA) but no cure currently exists. Mesenchymal stem cells (MSCs) immunomodulate inflammatory responses through paracrine signalling, including via secretion of extracellular vesicles (EVs) in the cell secretome. We evaluated the therapeutic potential of MSCs-derived small EVs in an antigen-induced model of arthritis (AIA).EVs isolated from MSCs cultured normoxically (21% O2, 5% CO2), hypoxically (2% O2, 5% CO2) or with a pro-inflammatory cytokine cocktail were applied into the AIA model. Disease pathology was assessed post-arthritis induction through swelling and histopathological analysis of synovial joint structure. Activated CD4+ T cells from healthy mice were cultured with EVs or MSCs to assess deactivation capabilities prior to application of standard EVs in vivo to assess T cell polarisation within the immune response to AIA.All EVs treatments reduced knee-joint swelling whilst only normoxic and pro-inflammatory primed EVs improved histopathological outcomes. In vitro culture with EVs did not achieve T cell deactivation. Polarisation towards CD4+ helper cells expressing IL17a (Th17) was reduced when normoxic and hypoxic EV treatments were applied in vitro. Normoxic EVs applied into the AIA model reduced Th17 polarisation and improved Th17:Treg homeostatic balance.Priming of MSCs in EV production can be applied to alter the therapeutic efficacy however normoxic EVs present the optimal strategy for broad therapeutic benefit. The varied outcomes observed in MSCs priming may promote EVs optimised for therapies targeted for specific therapeutic priorities. EVs present an effective novel technology with potential for cell-free therapeutic translation.</jats:p

Rationale and design of a longitudinal study of cerebral small vessel diseases, clinical and imaging outcomes in patients presenting with mild ischaemic stroke: Mild Stroke Study 3

Background: Cerebral small vessel disease is a major cause of dementia and stroke, visible on brain magnetic resonance imaging. Recent data suggest that small vessel disease lesions may be dynamic, damage extends into normal-appearing brain and microvascular dysfunctions include abnormal blood–brain barrier leakage, vasoreactivity and pulsatility, but much remains unknown regarding underlying pathophysiology, symptoms, clinical features and risk factors of small vessel disease. Patients and Methods: The Mild Stroke Study 3 is a prospective observational cohort study to identify risk factors for and clinical implications of small vessel disease progression and regression among up to 300 adults with non-disabling stroke. We perform detailed serial clinical, cognitive, lifestyle, physiological, retinal and brain magnetic resonance imaging assessments over one year; we assess cerebrovascular reactivity, blood flow, pulsatility and blood–brain barrier leakage on magnetic resonance imaging at baseline; we follow up to four years by post and phone. The study is registered ISRCTN 12113543. Summary: Factors which influence direction and rate of change of small vessel disease lesions are poorly understood. We investigate the role of small vessel dysfunction using advanced serial neuroimaging in a deeply phenotyped cohort to increase understanding of the natural history of small vessel disease, identify those at highest risk of early disease progression or regression and uncover novel targets for small vessel disease prevention and therapy