No description available.

No description available.

No description available.

Abstract Open aortic arch surgery almost always requires a bloodless operating field which necessitates the use of hypothermic circulatory arrest. Hypothermic circulatory arrest is a technique where the core temperature of a patient is lowered so that the systemic blood circulation can be stopped momentarily. This can cause unwanted damage to the brain. The risk for neurological impairment is at its highest when corrective surgery has to be performed in emergency situations. This highlights the need for additional neuroprotective methods. Our research group has used a porcine model described in this thesis for about 12 years in various setups to study many neuroprotective hypotheses. We have tested and researched surgical and CPB strategies that could be useful in a HCA and aortic arch reconstruction setting. In this thesis we have combined both chronic surviving animal data with acute experiments and aim to shed light on the mechanisms and efficacy of RIPC as neuroprotective method. In our experimental model, RIPC provided a mitigation of inflammatory response and cerebral injury after prolonged HCA. In general, the collected data showed homogeneity as similar biochemical results were seen in study I and II. Also interestingly, study III and IV possibly shed some light as to the mechanisms of the neuroprotective effect seen in Study II. These results seem to corroborate each other in a logical way. In study I which was acute experiment we saw faster EEG recovery rates in the intervention group. Additionally we recorded beneficial biochemical changes from samples that were collected from the brain. In our chronic study, were the animals were followed for a 7 day period after hypothermic circulatory arrest, we saw a statistically significant neuroprotective effect of remote ischemic preconditioning. In studies III and IV we attempted to shed light on the mechanisms. Study III revealed that an altered oxygen usage profile during hypothermic circulatory arrest and recovery phase might have a role in the neuroprotection. In study IV we saw a reduced microcirculatory leukocyte accumulation in cerebrocortical vessels was noted using an intravital microscope. The intravital microscope also provided results that indicated a difference in the redox state of the mitochondria via NAD+/NADH autofluorescence measurements. / Tiivistelmä Sydän- ja aorttakirurgiassa tarvitaan jossain tilanteissa täysin veretöntä leikkausaluetta. Verettömän leikkausalueen saavuttamiseksi joudutaan joskus turvautumaan potilaan elimistön jäähdytyksen jälkeiseen verenkierron pysäytykseen. Tämän menetelmän haittana on kuitenki aivokudokselle aiheutuva hapenpuute ja tästä mahdollisesti seuraava vaurioituminen. Vaurioitumisen riski on korkeimillaan erityisesti päivystyksellisissä tilanteissa. Tämän tutkimuksen tavoitteena on ollut selvittää, onko esialtistavalla raajaiskemialla kykyä suojata aivokudosta hapenpuutostilanteissa. Tutkimusryhmämme on viimeisen 12 vuoden aikana tutkinut sianporsailla eri keinoja, joilla voitaisiin parantaa aivojen suojausta sydän- ja aorttakirurgian aikana. Esialtistava raajaiskemia toteutetaan kiristämällä mansetti eläimen oikean takajalan ympärille. Tämän jälkeen mansetti täytetään viiden minuutin välein neljästi. Täyttökertojen välissä pidettään viiden minuutin tauko, jolloin mansetti on avatuna ja jalan verenkierto palautuu normaaliksi. Ensimmäisessä tutkimuksessamme totesimme, että esialtistava raajiskemia vaikuttaa aivojen sähkökäyrän toipumista nopeuttavasti. Toisessa tutkimuksessamme seurasimme koe-eläimiä seitsemän päivän ajan kokeen jälkeen. Tämän tutkimuksen yhteydessä toteutessa aivokudoksen mikroskooppiananalyysissä havaitsimme, että raajaiskemia vaikutti suojaavan aivokudosta hapenpuutteen aiheuttamilta aivovaurioilta. Kolmanessa tutkimuksessa selvitimme, että raajaiskemia vaikuttaa aivojen happipitoisuuteen sekä verenkierron pysäytyksen aikana että toipumisvaiheessa. Viimeisessä tutkimuksessa kuvasimme aivojen pintaverisuonia mikroskoopilla. Seurasimme kokeessa valkosolujen käyttäytymistä aivokudoksessa käyttäen fluoresoivia lääkeaineita. Havaitsimme, että raajaiskemiaryhmässä valkosoluja oli aivokudoksen pintaverisuonissa merkittävästi vähemmän. Lisäksi samalla menetelmällä tutkimme sitruunahappokiertoon osallistuvan NAD+/NADH parin suhteita autofluoresenssi ilmiöllä. Autofluorensenssi tutkimuksen tulokset viittaavat siihen, että mitokondrioiden hapetus/pelkistys kyky oli parempi raajaiskemia ryhmässä. Kokeissamme esialtistava raajaiskemia vähensi tulehdussolujen määrää aivokudoksessa sekä vähensi aivovauriota hapenpuutteen jälkeen.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13161号 / 論医博第2148号 / 新制||医||1029(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 大森 孝一, 教授 松本 智裕, 教授 秋山 芳展 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In ischemic stroke, damage to the brain is caused by a reduction or complete blockage of blood flow to parts of the brain, resulting in glucose and oxygen deficiency. It is a leading cause of mortality and disability particularly in the elderly. The majority of strokes are not fatal and survivors are at a high risk of subsequent vascular complications and new vascular accidents. Hypertension is the most important risk factor in strokes, being that it is present in 70% of all cases. Oxidative stress is believed to be one of the mechanisms taking part in neuronal damage in stroke. The key role the cholinergic system plays in normal brain functions and in memory disturbances of several pathological processes, such as in cerebral blood flow regulation, has been well documented. This study investigated the oxidative status and acetylcholinesterase (AChE) activity in whole blood in patients diagnosed with the acute and chronic stage of ischemia, as well as with hypertension. We determined the catalase activity in the blood, reduced glutathione (GSH) in erythrocytes, and TBARS and protein carbonyl content from serum samples. The oxidative profile of lipids and proteins represented by MDA levels and protein carbonylation content, respectively, showed increased levels both in the acute ischemic group and in the hypertensive group, when compared to the control. Catalase activity and GSH levels in the acute group also were higher than in the hypertensive and control groups. No difference was found between the catalase activity of the chronic ischemic group and the hypertensive group (p< 0.05). The activity of AChE in acute ischemic patients was significantly higher than that presented by the control, hypertensive and chronic ischemic patients (p<0.05). No significant difference was observed between the chronic and control groups. The hypertensive group presented AChE activity significantly lower than the other groups. The results suggest increased antioxidant defense as a compensatory mechanism in consequence of the overproduction of reactive oxygen species (ROS) after acute stroke. This sudy also demonstrated that hypertension, in and of itself, acts as a prevalent risk factor of stroke, contributing to oxidative cellular damage. Futhermore, the results revealed that ischemia exerted a modulator effect on AChE activity in erythrocytes, in an attempt to maintain adequate levels of the neurotransmitter acetylcholine (ACh), as a response to the differents phases following neurological injury caused by ischemia. The ischemic event, in spite of having a defined location, results in a systemic disorder that induces changes, which can be detect by mesuring the peripheral markers of oxidative stress and AChE activity in erytrocytes. / No acidente vascular isquêmico, o dano ao encéfalo é causado por uma redução ou um bloqueio completo do fluxo sangüíneo resultando em liberação deficiente de glicose e oxigênio. É uma das principais causas de mortalidade e incapacitação entre os idosos. Em sua maioria não são fatais e os sobreviventes têm alto risco de complicações vasculares subseqüentes. A hipertensão é o mais importante fator de risco para o acidente vascular cerebral, presente em 70% de todos os casos. Acredita-se que o estresse oxidativo é um dos mecanismos associados ao dano neuronal após o evento isquêmico. O papel chave que o sistema colinérgico desempenha nas funções normais do encéfalo e distúrbios de memória de vários processos patológicos assim como no controle do fluxo sanguíneo cerebral vem sendo bem documentado. Este trabalho investigou o perfil oxidativo e a atividade da enzima acetilcolinesterase sangüínea em pacientes com diagnóstico de acidente vascular cerebral isquêmico, na fase aguda e crônica assim como a influência da hipertensão em tal patologia. Determinou-se a atividade da catalase em sangue total, os níveis de glutationa reduzida em eritrócitos, TBARS e o conteúdo de proteína carbonil em amostras de soro da população estudada. O perfil oxidativo de lipídeos e proteínas, representado pelos níveis de MDA e conteúdo de proteína carbonil mostrou-se aumentado na fase aguda do evento isquêmico e no grupo hipertenso quando comparado com o controle. A atividade da catalase e os níveis de glutationa reduzida nos pacientes pertencentes ao estágio agudo encontraram-se aumentadas em relação aos grupos hipertenso e controle. Nenhuma diferença na atividade da catalase foi encontrada entre pacientes do estágio crônico da isquemia carebral e aqueles do grupo hipertenso (p<0,05). A atividade da AChE sangüínea durante a fase aguda do acidente vascular isquêmico foi aumentada em relação àquela apresentada pelos grupos controle, hipertenso e crônico (p< 0,05). Também, nenhuma diferença foi observada entre o grupo crônico e o controle. O grupo hipertenso apresentou atividade da AChE significativamente menor que os outros grupos. Os resultados sugerem que o aumento da defesa antioxidante age como um mecanismo compensatório como consequência da superprodução de espécies reativas de oxigênio (EROs) após o evento isquêmico agudo. Este estudo também demonstrou que a hipertensão atua como um fator de risco prevalente para o acidente vascular isquêmico, contribuindo para o dano oxidativo celular. Os resultados também revelaram que a isquemia exerce efeito modulador na atividade da AChE em eritrócitos, a fim de manter adequados níveis do neurotransmissor acetilcolina (ACh) em resposta as diferentes fases da injúria neurológica causada pela isquemia. Conclui-se então que o evento isquêmico, apesar de ter localização definida, resulta em uma desordem sistêmica, induzindo mudanças, as quais podem ser detectadas pela medida de marcadores periféricos do estresse oxidativo e atividade da AChE sangüínea.

Epidemiological studies report that infarct size is decreased and stroke outcomes are improved in young females when compared to males. However, mechanistic insight is lacking. We posit that sex-specific differences in glial cell functions occurring immediately after ischemic stroke are a source of dichotomous outcomes. In this study we assessed astrocyte Ca2+ dynamics, aquaporin 4 (AQP4) polarity, Sloop expression pattern, as well as, microglia morphology and phagocytic marker CD11b in male and female mice following 60 min of middle cerebral artery (MCA) occlusion. We reveal sex differences in the frequency of intracellular astrocyte Ca2+ elevations (F-(1,F-86) = 8.19, P = 0.005) and microglia volume (F-(1,F-40) = 12.47, P = 0.009) immediately following MCA occlusion in acute brain slices. Measured in fixed tissue, AQP4 polarity was disrupted (F-(5,F-86) = 3.30, P = 0.009) and the area of non-S100 beta immunoreactivity increased in ipsilateral brain regions after 60 min of MCA occlusion (F-(5,F-86) = 4.72, P = 0.007). However, astrocyte changes were robust in male mice when compared to females. Additional sex differences were discovered regarding microglia phagocytic receptor CD11b. In sham mice, constitutively high CD11b immunofluorescence was observed in females when compared to males (P = 0.03). When compared to sham, only male mice exhibited an increase in CD11b immunoreactivity after MCA occlusion (P = 0.006). We posit that a sex difference in the presence of constitutive CD11b has a role in determining male and female microglia phagocytic responses to ischemia. Taken together, these findings are critical to understanding potential sex differences in glial physiology as well as stroke pathobiology which are foundational for the development of future sex-specific stroke therapies. (C) 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

Diversos autores têm apontado o diabetes como fator de risco independente para a doença isquêmica do coração (DIC). Diferenças metodológicas têm, entretanto, prejudicado a comparabilidade de alguns estudos. O objetivo desta investigação foi testar a associação do diabetes mellitus com a DIC, procedendo-se a ajustamentos para as possíveis variáveis de confusão e/ou modificadoras de efeito. Avaliou-se também a existência de um gradiente dose resposta para as variáveis duração do diabetes, duração da hipertensão arterial, duração da hipercolesterolemia, duração do hábito de fumar, no cigarros consumidos/dia e duração da menopausa. O estudo foi planejado sob a forma de um desenho tipo caso-controle, tendo-se utilizado a estratégia de compor cinco bancos de dados, onde os casos foram comparados com cinco diferentes conjuntos de controles. Manteve-se nas análises de cada banco de dados o mesmo elenco de possíveis variáveis de confusão e/ou modificadoras de efeito. A população do estudo foi constituída por indivíduos de ambos o sexos, na faixa etária de 30 a 69 anos completos, sendo todos residentes no município de São Paulo. O estudo teve início em março de 1993 e estendeu-se até fevereiro de 1994. A amostra total foi composta por 833 indivíduos. A técnica estatística utilizada para análise dos dados foi a regressão logística multivariada. Os resultados do estudo permitiram identificar o diabetes mellitus como um fator de risco independente para a doença isquêmica do coração (\"odds ratio\" ajustado=2,6; I.C.95 por cento : 1,18- -5,80). O achado consistente de um possível efeito de proteção na categoria intermediária de duração do diabetes (>5$<10 anos) conduziu à hipótese de que o controle metabólico da doença, no período, poderia estar exercendo tal influência sobre o risco de DIC. Foi também possível identificar um efeito independente para as variáveis hipertensão arterial, hipercolesterolemia, hábito de fumar e antecedentes familiares de cardiopatia. Verificou-se, de forma consistente, a presença de um gradiente linear para duração da hipertensão arterial e número de cigarros consumidos/dia. As interações consideradas de interesse, combinando-se história positiva de diabetes com as categorias de exposição das outras variáveis não apresentaram significância estatística. São discutidas algumas razões de ordem metodológica que exerceriam influência sobre a magnitude das medidas de efeito em diferentes combinações de controles. / Several authors have reported diabetes as an independent risk factor to ischaemic heart disease (IHD). However, the use of different methodologies have been an obstacle in comparing these studies. The objective of this investigation was to test the association between diabetes and IHD, after adjusting for known confounders and/or modifiers of effect. There was interest in evaluating the existence of a linear gradient for known duration of diabetes, arterial hypertension, hypercholesterolemia, menopause, smoking and daily number of cigarretes consumed. The study was designed as a case-control and the cases were compared with five different kinds of controls. The same group of variables were maintained in the analysis. The population was composed by male and female, aged 30-69 years living in the city of São Paulo. The period of the study was one year (march/93 until february/94). The sample included 833 individuais. Logistic regression was the statistical method to analysis of the data. The results showed that diabetes is an independent risk factor to lliD (adjusted odds ratio=2.6; C.I.95 per cent : 1.18-5.80). There was a consistent protection effect on the \">5 <1O\" years stratum of known duration of diabetes and it was proposed that metabolic control of diabetes during this period had some influence to the IHD risk. Hypertension, hypercholesterolemia, smoking and familial antecedents of cardiovascular diseases were considered major risk factors to IHD. It was detected a linear gradient for known duration of hypertension and daily number of cigarettes consumed. The interaction between diabetes and exposure levels of other variables did not present statistical significance. Some methodological issues are presented to explain different magnitudes of effect according to the different kinds o f controls.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O acidente vascular cerebral, doenÃa incapacitante e terceira causa de morte em paÃses desenvolvidos à caracterizada pela interrupÃÃo ou reduÃÃo do fluxo sangÃÃneo para o cÃrebro capaz de causar alteraÃÃo na funÃÃo cerebral. Sabe-se que o receptor A1 da adenosina possui um papel chave na neuroproteÃÃo devido à diminuiÃÃo da liberaÃÃo de glutamato e hiperpolarizaÃÃo neuronal. O objetivo desse trabalho foi determinar os efeitos do prÃ-condicionamento por estresse de contensÃo em ratos submetidos à isquemia cerebral transitÃria (ICT) por oclusÃo bilateral das carÃtidas e a participaÃÃo dos receptores A1 da adenosina nesse processo. Inicialmente, ratos Wistar machos, entre 200-240g, foram submetidos ao estresse de contensÃo (ST) em cilindros por 2h e imediatamente depois submetidos à ICT pela oclusÃo de ambas as artÃrias carÃtidas durante 30min. Um dos grupos dos animais foi prÃ-tratado com o antagonista do receptor A1 da adenosina, DPCPX, antes do estresse de contensÃo nas doses de 0,1mg/kg ou 1mg/kg. A temperatura retal foi monitorada e mantida a 37ÂC atravÃs de uma luz incandescente. Vinte e quatro horas depois do tÃrmino da ICT os animais foram sacrificados, tiveram seus cÃrebros dissecados, seccionados e imersos em soluÃÃo de Cloreto de 2,3,5-Trifeniltetrazol (TTC) a 1% por 30 min. para analise da viabilidade do tecido cerebral. Os testes comportamentais foram efetuados 72h apÃs a ICT e consistiram em Teste do Campo Aberto para a atividade locomotora, Labirinto em Y para a memÃria operacional ou de procedimento e Esquiva Passiva para aferiÃÃo da memÃria aversiva de curta e longa duraÃÃo. Os animais submetidos à ICT tiveram dano no tecido cerebral (FO= 10,36  0,75%; ISQ= 18,52  2,62%) alÃm de diminuiÃÃo no comportamento exploratÃrio de rearing (no de eventos: FO= 5,00 1,23; ISQ= 1,50  0,72) e dÃficit da memÃria aversiva de longa duraÃÃo (FO= 271,2  17,61s; ISQ= 108,4 67,64s). Nenhuma diferenÃa significativa foi encontrada no nÃmero de cruzamentos em Campo Aberto (FO= 15,71 2,02; ISQ= 11,00 2,13), na memÃria de procedimento (FO= 70,16  5,77; ISQ= 71,37  7,94), ou na memÃria aversiva de curta duraÃÃo (FO= 145,9  42,75; ISQ= 113,1  64,97).Os animais prÃ-condicionados por estresse tiveram uma reduÃÃo na taxa de infarto cerebral (FO= 10,36  0,75%; ISQ= 18,52  2,62%; ISQ+ST= 12,59  0,87%) e um retorno aos nÃveis normais do comportamento de rearing observado no teste do campo aberto (FO= 5,00 1,23; ISQ= 1,50 0,72; ISQ+ST= 6,091 1,443). No teste de esquiva passiva, observamos uma tendÃncia à melhora da memÃria aversiva de longa duraÃÃo (FO= 271,2  17,61s; ISQ= 108,4 67,64s; ISQ+ST= 156,1Â45,81s). Quando tratados com o DPCPX na dose de 1mg/kg, os animais tiveram um bloqueio da neuroproteÃÃo obtida com o prÃ-condicionamento (ISQ= 18,52  2,62%; ISQ+ST= 12,59  0,87%; ISQ+ST+DPCPX 1= 19,95  3,38%), aumento no nÃmero de rearings que havia sido normalizada pela contensÃo (ISQ= 1,50 0,72; ISQ+ST= 6,091 1,443; ISQ+ST+DPCPX 1= 3,20 0,90) e uma tendÃncia à reversÃo dos efeitos do prÃ-condicionamento na memÃria aversiva de longa duraÃÃo (ISQ= 108,4 67,64s; ISQ+ST= 156,1Â45,81s; ISQ+ST+DPCPX 1= 88,61 38,83s). O estresse de contensÃo conferiu neuroproteÃÃo aos animais submetidos à ICT e tal neuroproteÃÃo foi perdida pelo tratamento prÃvio com DPCPX. Esses achados apontam para a participaÃÃo do receptor A1 da adenosina na proteÃÃo conferida por estresse de contensÃo por mecanismos que ainda precisam ser esclarecidos. / Stroke,as disabling disease and as third cause death in developed countries, is characterized for the interruption of cerebral blood flow capable to cause alteration on brain functions. It is well established that the activation of A1 adenosine receptor confers neuroprotection against acute noxious brains stimuli. The aim of this study was to investigate the effects of preconditionnement by restraint stress on rats subjected to transient cerebral ischemia (TCI) and the participation of A1 receptor in this process. Firstly, Wistar male rats weighing 200-240g were exposed to immobilisation stress for 2 hours followed to TCI by occlusion of both carotid arteries for 30 minutes. Group of animals were pretreated with A1 receptor antagonist DPCPX (0,1mg/kg or 1 mg/kg. i.p.) before immobilisation stress. Retal temperature was monitored and 37ÂC were maintened during cirurgical procedure using a heating light. Infarct size was determined by TTC staining 24h after TCI and the behavioral tests were performed after 72 hours. Open field test were used to assess locomotor activity, Y-maze test for working memory and passive avoidance test to aversive short and long term memory evaluation. Our results showed that TCI caused damage on brain tissue (sham operated= 10.36  0.75%; ISC= 18.52  2.62%), decreased the vertical exploratory behavior (number of events: sham= 5.00  1.23; ISC= 1.50  0.72) and deficit on long term aversive memory (sham= 271.2  17.61s; ISC= 108.4  67.64s). No differences were found on the crossing behavior (sham= 15.71  2.02; ISC= 11.00  2.13), working memory (sham= 70.16  5.77; ISC= 71.37  7.94) neither short term memory (sham= 145.9  42.75; ISC= 113.1  64.97). The infarct volume rates on restraint stress (RS) group were significantly less than ischemic (ISC) group (sham= 10.36  0.75%; ISC= 18.52  2.62%; RS= 12.59  0.87%) while the number of rearing were significantly higher (sham= 5.00 1.23; ISC= 1.50 0.72; RS= 6.091 1.443). On the passive avoidance test, restraint stress tend to impair the ischemic damage on the long term memory (sham= 271.2  17.61s; ISC= 108.4  67.64s; RS= 156.1  45.81s). When treated with DPCPX (1mg/kg) the infarct size show an increase (ISC= 18.52  2.62%; RS = 12.59  0.87%; DPCPX= 19.95  3.38%) suggesting a blockade of neuroprotection action achieved by restraint stress. DPCPX also decreased the number of rearing on the open field test (ISC= 1.50  0.72; RS= 6.091 1.443; DPCPX = 3.20  0.90) and tend to reverse the improvement of long term aversive memory accessed by restraint stress (ISC= 108.4  67.64s; RS= 156.1  45.81s; DPCPX 1= 88.61 38.83s). This work showed a neuroprotection of pre conditioning restraint stress against cerebral ischemia and the blockade of this action by a previously administration of DPCPX, A1 adenosine antagonist. These findings point to the involvement of the A1 adenosine receptor in the protection conferred by restraint stress by mechanisms that still need to be clarified.

archives@tulane.edu / Experimental stroke in endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) knockout mice showed diverse effects on brain injury. nNOS and eNOS have been shown to uncouple in pathological conditions to produce superoxide. Oxidative stress is believed to be the underlying cause of several cardiovascular diseases including ischemic stroke. However, the role of eNOS and nNOS uncoupling in ischemic stroke is not well studied. Our objective of the study was to determine the effect of eNOS and nNOS inhibition on reactive oxygen species (ROS), NO, viability and mitochondrial bioenergetics in rat brain microvascular endothelial cells (BMECs) and rat cortical neurons following oxygen-glucose deprivation-reoxygenation (OGD/R). We found that non-specific inhibition of NOS in endothelial cells reduced ROS levels in BMECs but increased ROS levels in neurons under normoxia. This suggests that a pool of uncoupled NOS exists in the BMECs whereas the dominant functional NOS in neurons produces NO. We observed increased levels of ROS following OGD/R that is sensitive to NOS inhibition in both BMECs and neurons indicating eNOS and nNOS uncoupling during OGD/R. Furthermore, NOS inhibition reduced mitochondrial respiration while it improved cell survival rate in both BMECs and neurons following OGD/R. Thus, it is possible that decreased mitochondrial respiration in the immediate aftermath (4 hours) of OGD/R could be protective against reoxygenation injury. Moreover, we identified the expression of nNOS in BMECs from rat, human, and mouse. We observed that the nNOS in the BMECs constitutively produces superoxide under physiological conditions instead of NO. In contrast, nNOS in the neurons produces NO and doesn’t contribute to ROS. We also confirmed the nNOS expression and its function in freshly isolated rat brain microvessels. In addition, we developed a novel method to measure mitochondrial respiration in freshly isolated mouse brain microvessels using Seahorse XFe24 Analyzer. We validated the method by demonstrating impaired mitochondrial respiration in cerebral microvessels isolated from old mice compared to young mice. In summary, the present doctoral research investigated the distinct role of NOS isoforms in BMECs and Neurons leading to the identification of novel functional variant of nNOS in BMECs and brain microvessels. / 1 / RAMARAO SVNL