Strong evidence has linked dietary sodium intake to blood pressure, but the effects of sodium intake on cardiovascular diseases (CVD) outcomes remain elusive, especially for older population. We examined the association between estimated usual sodium intake and CVD and all-cause mortality in a nationally representative sample of 4068 US adults aged 51 and older surveyed in 1988-1994. After a mean follow-up of 12.9 years from 1988 to 2006, 1680 participants died: 734 from CVD; 392 from ischemic heart disease (IHD); and 144 from stroke. In the Cox proportional models adjusted for sociodemographic variables and CVD risk factors, sodium intake was not significantly associated with all-cause, CVD, IHD and stroke mortality. No significant interactions were observed between sodium intake and sex, race/ethnicity, hypertension status, body mass index or physical activity for any of the outcomes studied. However, among Mexican-Americans sodium intake was significantly and linearly associated with CVD mortality.

In adult rats, following unilateral stroke-like injury to the motor cortex, there is significant loss of function in the forelimb contralateral to the ischemic damage. In the remaining motor cortex, changes in neuronal activation patterns and connectivity are induced following motor learning and rehabilitation in the brains of adult animals. Rehabilitative training promotes functional recovery of the impaired forelimb following motor cortical strokes; however, its benefits are most efficacious when coupled with other rehabilitative treatments. Multiple lines of evidence suggest that focal cortical electrical stimulation (CS) enhances the effectiveness of rehabilitative training (RT) and promotes changes in neural activation and plasticity in the peri-lesion motor cortex. Specific examples of plastic events include increases in dendritic and synaptic density in the peri-lesion cortex following CS/RT compared to rehabilitative training alone. The objective of these studies was to investigate which conditions, such as timing and method of delivery of CS, when coupled with RT, are most efficacious in promoting neuronal plasticity and functional recovery of the impaired forelimb following ischemic cortical injury in adult animals. The central hypothesis of these dissertation studies is that, following unilateral stroke-like injury, CS improves the functional recovery of the impaired forelimb and promotes neural plasticity in remaining motor cortex when combined with RT. This hypothesis was tested in a series of experiments manipulating post-ischemic behavioral experience with the impaired forelimb. Adult rats were proficient in a motor skill (Single Pellet Retrieval Task) and received ischemic motor cortex lesion that caused impairments in the forelimb. Rats received daily rehabilitative training on a tray reaching task with or without concurrent cortical stimulation. Epidural cortical stimulation, when paired with rehabilitative training, resulted in enhanced reaching performance compared to RT alone when initiated 14 days after lesion. These results were found to be maintained well after the treatment period ended. Rats tested 9-10 months post-rehabilitative training on the single pellet retrieval task continued to have greater reaching performance compared to RT alone. However, delayed onset of rehabilitative training (3 months post-infarct) indicated that CS does not further improve forelimb function compared to RT along. It was further established that CS delivered over the intact skull (transcranial stimulation) of the lesioned motor cortex was not a beneficial adjunct to rehabilitative training. Together these dissertation studies provide insight into the effectiveness and limitations of CS on behavioral recovery. The findings in these studies are likely to be important for understanding how post-stroke behavioral interventions and adjunct therapies could be used to optimize brain reorganization and functional outcome. / text

This study investigated the effects of SEA0400, a Na+/Ca2+ exchange inhibitor, in cardioplegia on rat myocyte contractile function. SEA0400 significantly reduced the accumulation of diastolic Ca2+ throughout cardioplegic arrest compared to ischemic control and cardioplegia. Cells treated with SEA0400 during cardioplegic arrest showed significantly larger Ca2+ transient amplitudes and contractions throughout reperfusion compared to cells treated with cardiopelgia alone. Intracellular Ca2+ stores were similar in both cardioplegic groups at baseline and during reperfusion. Together these results suggest that SEA0400 has beneficial effects at protecting ventricular myocytes during cardioplegic arrest and that SEA0400 in cardioplegia may affect myofilament Ca2+ sensitivity.

The contribution of single complement system (CS) activation pathways to cerebral IR injury has not yet been adequately studied after ischemic stroke and reperfusion. It remains unclear whether a specific activation pathway (alternative, classical or lectin), single complement factors within the CS, or anaphylatoxins are responsible for increased cerebral IR injury after ischemic stroke and reperfusion. Also poorly understood is the relationship between these elements (activation pathways, CS factors and anaphylatoxins) and neutrophil mediated cerebral IR injury. The objective of this dissertation was to test the hypothesis that mannose binding lectin (MBL) deficiency during cerebral ischemia and reperfusion will result in a significant reduction of systemic neutrophil activation and cerebral injury after ischemic stroke and reperfusion via decreased CS activation and subsequent decreased anaphylatoxin production. Using the intraluminal filament method, mice with targeted mutations to MBL A/C genes (MBL-/- ) or the C57Bl/6 strain (MBL +/+ ) were subjected to 60 minutes of cerebral ischemia and either 15 minutes or 24 hours of reperfusion. After reperfusion (15 min and 24 hour) blood was removed to assess systemic neutrophil CD11b expression via flow cytometry. After 24 hours of reperfusion, the brain was removed to assess cerebral injury. CS activation after ischemic stroke and reperfusion was assessed via immunofluorescent C3 staining and RT-rtPCR methods. Our primary findings are, after ischemic stroke and reperfusion: (1) hepatic MBLA gene expression is significantly increased, (2) systemic neutrophils significantly express CD11b, (3) MBL deficiency significantly decreased cerebral infarct volume in the striatum but not in the cortex or total hemisphere, and (4) systemic neutrophil activation is independent of MBL deficiency. This study is the first to examine the contribution of MBL-initiated lectin pathway activation to cerebral IR injury after ischemic stroke and reperfusion. These findings suggest that MBL deficiency does not significantly reduce neutrophil activation or protect brain tissue after ischemic stoke and reperfusion. A complete understanding of reperfusion events after ischemic stroke is necessary for successful development of future stroke therapies to prevent cerebral IR injury. In this way, the acquisition of knowledge from the bench serves the stroke population cared for by nurses at the bedside.

Ischemic stroke is characterized by a disruption of blood supply to a part of the brain tissue, which leads to a focal ischemic infarct. The expression and activity of MMP-9 is increased in ischemic stroke and is considered to be one of the main factors responsible for damages to the cerebral vasculature, resulting in compromised blood-brain barrier (BBB) integrity. However, the regulatory mechanisms of MMP-9 expression and activity are not well established in ischemic stroke. Since hypoxia/ischemia and reperfusion generates reactive oxygen species (ROS), I hypothesize that ROS is one of factors involved in up-regulation of MMP-9 expression in brain cells and ROS-mediated effect may occur via MAPK signaling pathway. My study has provided the evidence that ROS is responsible for an increase in MMP-9 expression in astrocytes mediated via MAPK-AP1 signaling pathway. Preliminary studies with an in vitro model of the BBB suggest that inhibition of MMP-9 is a critical component of reducing ROS-induced BBB permeability.

The disruption of the blood-brain barrier (BBB) occurs after ischemic and hemorrhagic stroke and contributes to secondary brain damage. Matrix metalloproteinase-9 (MMP9) has been identified to be the main mediator of post-stroke BBB disruption. It is unknown whether deposition of heme/iron in the brain following stroke would affect MMP9 expression. In this study, I have demonstrated that heme/iron up-regulated MMP9 expression in rat astrocytes and that this upregulation was most likely due to reactive oxygen species (ROS) generated by heme/iron deposition on cells. ROS can activate AP-1 and NFκB signaling pathways which were responsible for increased MMP9 expression. Inhibiting AP-1 and NFκB decreased MMP9 expression. Heme/iron deposition also activated Nrf-2 and increased the expression of neuroprotective heme oxygenase-1. My study suggests that heme and iron deposition generates ROS and increases MMP9 expression through AP-1 and NFκB signaling pathways and that targeting these pathways or clearance of heme and iron may modulate MMP9 expression for reduced damage.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. Includes bibliographical references.

Thesis (Ph.D.)--Memorial University of Newfoundland, Faculty of Medicine, 2000. / Typescript. Bibliography: p. 137-164.

Introdução: A atresia biliar (AB) é uma doença que se inicia na infância e caracteriza-se por obstrução das vias biliares extra-hepáticas, e por colangiopatia progressiva, de etiologia desconhecida. Seu tratamento consiste numa portoenterostomia, cujo sucesso é variável. Fatores como a idade na portoenterostomia e normalização de bilirrubinas séricas influenciam a sobrevida do paciente com seu próprio fígado. Nosso grupo estuda o envolvimento de uma arteriopatia na etiologia da AB. O fator de crescimento vascular endotelial (VEGF) e seus receptores VEGFR1 e VEGFR2 participam da angiogênese em situações de distúrbio vascular. Objetivo: Quantificar a expressão gênica de VEGFA e seus receptores, relacionando com variáveis moleculares, morfométricas e clínico-laboratoriais associadas com a gravidade da AB e o prognóstico pós-portoenterostomia. Métodos: Estudo de amostras de biópsias em cunha coletadas na laparotomia exploradora de pacientes com AB, na sua forma isolada IgM- para citomegalovírus (n= 32), comparando com lactentes com colestase intra-hepática (CIH, n= 09), pareados por idade. Uma amostra foi ultracongelada (análise molecular) e outra, parafinizada (análises histológica e imunoistoquímica). A expressão dos genes angiogênicos (VEGFA, VEGFR1 e VEGFR2), fibrogênico (MCP1, proteína quimiotática de monócitos) e de reação ductular (CK19, citoqueratina 19), além do gene normalizador, ribossomal 18S, foi medida por PCRq com sondas TaqMan®. As análises morfométricas, a partir de material parafinado, incluindo extensão de fibrose e reação ductular foram mensuradas através do programa Image Pro Plus 6.0. Variáveis clínico-laboratoriais foram prospectivamente coletadas no banco de dados da Unidade de Hepatologia Pediátrica do HCPA. Resultados: VEGFR2 foi menos expresso na AB em comparação com CIH (P <0,001), enquanto não houve diferença significante na expressão de VEGFR1 (P= 0,086) e apenas uma tendência de menor expressão do VEGFA (P= 0,060) no grupo AB. Quanto à expressão de VEGFA e VEGFR2, dois subgrupos de AB foram observados: um com expressão levemente superior ou igual à CIH e outro com expressão 3 vezes menor que a mediana do grupo CIH. Os subgrupos com menor expressão foram denominados loVEGFA e loVEGFR2. Na AB, a expressão do VEGFA teve correlação positiva com a de seus receptores VEGFR1 e VEGFR2 (rs=0,8; P<0,001 e rs=0,5; P=0,001). A expressão de VEGFR2 teve uma forte correlação negativa com a idade na portoenterostomia (rs=-0,6;P=0,001). As bilirrubinas séricas total e direta foram negativamente correlacionadas com VEGFA (rs=-0,5;P=0,007 e rs=-0,4;P=0,033) e VEGFR2 (rs=-0,5;P=0;004 e rs=-0,6;P=0,001). No subgrupo loVEGFR2 a expressão de CK19 estava diminuída, e a de MCP1 não se associou à expressão gênica das moléculas angiogênicas. Conclusões: Na AB há um subgrupo com diminuição na expressão de VEGFA e VEGFR2. A expressão de ambas as moléculas correlacionou-se ao comportamento das variáveis associadas a gravidade da doença e obstrução do fluxo biliar na portoenterostomia, incluindo bilirrubinas séricas e idade. O subgrupo de baixa expressão do VEGFR2 apresentou diminuição da massa de colangiócitos, segundo a expressão do CK 19, mas foi independente da expressão do marcador de fibrose, MCP1. / Background: Biliary atresia (BA) is a disease that begins in infancy and is characterized by complete obstruction of extrahepatic biliary ducts and a progressive cholangiopathy of undefined etiology. Treatment of BA consists of a portoenterostomy, whose success is variable. Factors such as age at portoenterostomy and post-operative normalization of serum bilirubin influence the native liver survival. Our group studies the role of an arteriopathy, and thus of hypoxia, in the etiology of BA. Expression of vascular endothelial growth factor (VEGF) A and its receptors, VEGFR1 and VEGFR2, induce angiogenesis in response to hypoxia. Aim: To assess gene expression of VEGFA and its receptors in BA, correlating with molecular, morphometric and clinical-laboratory variables associated with the disease severity and the post-portoenterostomy prognosis of BA. Methods: Liver biopsy specimens collected at exploratory laparotomy of age-matched patients with isolated, cytomegalovirus IgM-negative BA (n=32) and intrahepatic cholestasis (IHC, n=9) were evaluated. A sample was ultrafrozen (for molecular analysis) and the other was paraffin-embedded (for histological and morphometric analyzes). The expression of genes involved in angiogenic (VEGFA, VEGFR1 and VEGFR2), biliary fibrosis (MCP1 - monocyte chemotaxis protein 1) and cholangiocyte phenotype (CK19 – cytokeratin 19), was measured by TaqMan® probes with qPCR, using ribosomal 18S as the normalizing gene. Extents of fibrosis and ductular reaction were morphometrically assessed using the Image Pro Plus 6.0. Clinical-laboratory variables were collected from the database of the Pediatric Hepatology Unit of Hospital de Clínicas de Porto Alegre. Results: VEGFR2 was less expressed in BA compared with IHC (P <0.001), whereas there was no significant difference in the expression of VEGFR1 (P=0.086) and only a trend of a lower expression of VEGFA (P=0.060) in the BA group. Regarding VEGFA and VEGFR2, two subgroups of BA were defined: low expression, with values 3 times lower than the median of the IHC group, and high expression. In BA, VEGFA expression was positively correlated with that of VEGFR1 and VEGFR2 (rs=0.8, P<0.001; rs=0.58, P=0.001). The expression of VEGFR2 had a strong negative correlation with age at portoenterostomy (rs=-0.6, P=0.001). Total and direct reacting bilirubins were both negatively correlated with VEGFA expression (rs=-0.5, P=0.007; rs=-0.4,P=0.033) and VEGFR2 (rs=-0.5,P=0.004; rs=-0.6,P=0.001). In the low VEGFR2 expression (loVEGFR2) subset, gene expression of CK19, marker of cholangiocyte phenotype, was decreased. MCP1, marker of fibrosis, was not associated with he expression of the angiogenic factors. Conclusion: In BA there is a subset of patients with decreased expression of VEGFA and VEGFR2. The expression of these molecules is correlated with variables associated to disease severity and bile flow obstruction at portoenterostomy, including age and serum bilirubin levels. The loVEGFR2 expression is associated with a decreased cholangiocyte mass as evaluated by CK19 expression, and is independent of the expression of the fibrosis marker MCP1.