Citations

The cardinal signs of systemic metabolic dysfunction, including insulin resistance, hypertension and a systemic pro‐inflammatory state are risk factors for the development of cardiovascular disease, type 2 diabetes, and neurodegenerative conditions, but there is limited information regarding the impact on recovery after spinal cord injury (SCI). To address this gap, we investigated the impact of systemic insulin resistance generated by consumption of a diet high in fat and sucrose, often referred to as a Western Diet, on neuropathophysiological outcomes in a murine compression model of incomplete SCI. Ten‐week‐old female C57BL6 mice were provided a regular diet (RD) or a diet high in fat and sucrose (HFHS) for 7 weeks prior to experimental compression SCI. Mice consuming a Western Diet showed signs of systemic insulin resistance such as evaluated blood glucose. In addition, signs of insulin resistance within the substance of the spinal cord were also observed, including reductions in the abundance of insulin‐like growth factor 1 receptor (IGF‐1R). Impairments in motor recovery evaluated by BMS score and subscore were present in mice consuming HFHS at 14 and 30 days post injury (dpi). Consumption of a diet rich in fat and sucrose also impaired the mean maximal angle achieved on the inclined plane test and resulted in significant impairments in bladder release. Immunochemical analysis of the spinal cord revealed a number of differences in markers of neural injury between the two groups. First, mice consuming HFHS exhibited significant increases in astrogliosis measured by glial fibrillary acidic protein (GFAP) prior to injury, compared to mice consuming a RD. In fact, the prominent increases in GFAP observed in the intact spinal cord of mice consuming HFHS were equivalent to those observed after SCI in mice consuming a regular chow. In the subacute period, markers of microglial/monocyte activation were elevated in all mice with SCI; however, the increase was substantially greater in the spinal cords of mice consuming HFHS. The spinal cord white matter of mice consuming HFHS also showed reductions in the number of oligodendrocyte progenitor and mature myelinating cells prior to SCI and HFHS‐associated reductions in myelin producing cells persisted at 14 and 30 dpi. In addition, loss of serotonergic axons in the spinal cord after SCI was exacerbated in mice consuming HFHS. Growth associated protein 43 (GAP43), a marker of axonal growth cones was elevated after SCI in the spinal cords of mice consuming a RD or a HFHS diet; however, the magnitude of the increase in growth cones was severely impaired in mice consuming HFHS. These findings suggest that consumption of a Western Diet increases the risk of insulin resistance within the central nervous system and impairs neurobehavioral recovery after SCI. These studies highlight insulin resistance as a new mechanism that limits nervous system repair after SCI and as a potential target for intervention to improve functional outcomes. Support or Funding Information NIH R01 NS052741 and The Minnesota State SCI and TBI Research Grant Program. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

We recently demonstrated that high dietary fat (HFD) consumption results in a dramatic loss of myelinating cells and their progenitors in the adult CNS (Yoon et al., 2016). However, the mechanism(s) by which HFD drives dysmyelination are unknown. Since epidemiological studies indicate that metabolic syndrome is a key risk factor for multiple sclerosis (MS), a better understanding of how HFD contributes to oligodendrocyte loss and the capacity for myelin regeneration has the potential to highlight new treatment targets. In mice fed HFD, we found significant decreases in vertical activity by 4 wk and significant changes in ambulatory and stereotypy movements by 12 wk in the Open Field Test. HFD‐fed mice also spent less time in the center of the field as opposed to the perimeter, indicating an anxious phenotype. Mitochondrial isolated from the spinal cord of mice consuming HFD for 4 wk had significantly higher state 3 and state 4 respiration as determined by high‐resolution respirometry. However, by 12 wk, state 4 mitochondrial respiration was significantly less in the HFD group. Targeted LC‐LC‐mass spectroscopy approaches demonstrated that Citric Acid Cycle intermediates are also depleted in the spinal cord of mice consuming HFD for 12 wk compared to controls. Changes in genes related to mitochondrial morphology, quality control processes, and oxidative stress response were also found. In addition, there were significantly fewer Olig2+ cells and increased signs of lipid peroxidation products (4‐Hydroxynonenal‐immunoreactivity) in the corpus callosum of HFD consuming mice compared to those fed a regular diet. Supporting in vivo findings that oligodendrocytes are reduced in the spinal cord of mice consuming HFD, we observed increased mitochondrial fragmentation and a reduced oxygen consumption rate in oligodendrocyte precursors cultured with palmitic acid. Astrocytes however, significantly increased oxygen consumption following exposure to palmitic acid. Together, these findings suggest that changes in the adult spinal cord in response to HFD consumption creates an environment that is less conducive to neural repair by impacting mitochondria function and morphology and impairing oligodendrocyte function. To determine any impact of HFD on myelin regeneration, studies are ongoing to examine myelin regeneration using a murine model of Cuprizone‐mediated demyelination. Neurobehavioral assessments to date reveal significant interactions between HFD and myelin injury and repair. Understanding the cellular environment in response to dietary factors such as HFD consumption can help to guide care for individuals with MS and other conditions in which myelin loss plays a pathological role and has potential to identify new targets for intervention. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Trauma to the CNS generates a proteolytic imbalance that contributes to secondary injury, including axonopathy and neuron degeneration; however the mechanism by which this occurs is not well understood. Kallikrein 6 (KLK6) is a serine protease implicated in neurotoxicity and in these studies we investigate the role of protease activated receptors (PARs) in mediating these effects. We demonstrate KLK6 and the prototypical activator of PAR1, thrombin, as well as PAR1 and ‐2, are each elevated in a murine experimental spinal cord injury at acute or subacute time points. KLK6 and thrombin each promoted cerebellar granule neuron toxicity and potentiated glutamate excitotoxicity in vitro. Importantly, neural injury in each case was reduced or blocked in neurons derived from PAR1 deficient mice. KLK6 was shown to activate ERK in cerebellar neurons in a PI3K and MEK‐dependent fashion. Novel lipopeptide inhibitors specific for PAR1 or PAR2, in addition to neurons derived from PAR1 deficient mice were utilized to demonstrate both receptors play an important role in KLK6‐elicited ERK signaling and in the activation of the proapoptotic protein Bim. Taken together these data point to novel KLK6‐PAR1 and ‐PAR2 mediated signaling cascades in CNS neurons that are positioned to participate in neuron degeneration and glutamate‐mediated excitotoxicity in cases of CNS injury. Supported by NIH R01 NS052741

A remarkable feature of the expression of kallikrein 6 (KLK6) in the CNS is its abundance in oligodendroglia and neurons, but relative lack of expression in astrocytes. We have shown in cases of CNS injury however, that KLK6 is induced in reactive astrocytes and exhibits prolonged expression in astroglial scar tissue in cases of spinal cord injury, multiple sclerosis and glioblastoma multiforme. In this study, we address the hypothesis that KLK6 plays a role in the promotion of astrogliosis and that this occurs by selective activation of protease activated receptors (PARs). Using primary murine astrocytes we show KLK6 promotes rapid transformation from an epithelioid to a stellate morphology and secretion of interleukin 6, each a hallmark of astrogliosis. The ability of KLK6 to promote stellation was shown to occur as early as 4 hours after a single pulse of KLK6, to be dose‐dependent, and to require activation of PKC and AKT signaling cascades. The stellation promoting activities of KLK6 were further shown to depend at least in part on activation of the thrombin receptor PAR1, since these effects were reduced in astrocytes derived from PAR1‐deficient mice and by a PAR1 specific inhibitor, SCH79797. These results point to novel roles for KLK6‐mediated PAR signaling in the spectrum of events that culminate in astrogliosis. This work was supported by NIH R01 NS052741.

Introduction: There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines. Materials and Methods: The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH. Discussion: It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.

11550 Background: RPS often have local recurrence (LR) after surgery. Preoperative radiation (RT) to 50.4 Gy can reduce LR risk but is not uniformly effective, especially after (+) margin resections. Therefore, we conducted a multi-institutional, prospective Phase II study to assess efficacy and tolerability of preop IMPT with selective dose escalation to 63 GyRBE to the posterior RPS margin (clinical target volume [CTV] 2) at high risk for (+) margins to further reduce the risk of LR. This dose was tolerable in a prior phase I study (DeLaney T et al, 2017, PMID:28740917). Methods: Primary RPS patients (pts) >18 years received preop IMPT, 50.4 GyRBE in 28 fractions (fx) of 1.8 GyRBE to CTV1 (tumor plus adjacent tissue at risk of subclinical disease) with SIB to CTV2 to 63.0 GyRBE in 28 fx of 2.25 GyRBE. Pts with high-grade tumors could get chemotherapy(CTX) prior to IMPT. To avoid treatment delay, 11 fx of IMRT x-rays could be substituted for IMPT. Pts had restaging and surgery 4-8 weeks after IMPT. Primary study endpoint was local tumor control. Secondary endpoints included clinical and pathologic response, surgical margin status, and disease-free and overall survival. Results: We accrued 60 pts from January 2016 to February 2021. Histology: 35 liposarcoma(LPS) (19 dediff and 16 well diff), 22 leiomyosarcoma(LMS), and 3 undifferentiated pleomorphic sarcoma. IMPT was delivered per protocol in all pts. 51 pts have had surgery, 5 are awaiting surgery, and 4 had no surgery due to metastases(DM) on preop imaging. 22 pts had (+) margins. 2 pts had > 75% necrosis. With 23-month median (range 1-52 months) follow-up after start of RT, there were two LRs. A dediff LPS pt had a well diff LPS LR 26 months postop, resected, and is disease-free. A renal vein/IVC LMS pt treated with CTX and IMPT had LR and DM 4 months postop and died from disease. Surgical Clavien-Dindo morbidity scores: 0(21), 1(9), 2(8), 3a (4), 3b(4), 4a(2), 4(b)1, 5(2); the periop deaths were from sepsis(pneumonia) and duodenal ulcer. The grade 3-4 periop morbidity included abscess(3), treated by catheter(2) or operative(1) drainage, prolonged hospital stays (2 pts with IVC LMS), small bowel obstruction (1), and late sigmoid colon anastomotic failure (1). Readmissions for lymphopenia(1), pneumoperitoneum (1), and volume overload (1). One late neuropathy was seen in a Type II diabetic pt with transient postop weakness after femoral nerve dissection who later had significant lower extremity weakness 3.75 years postop. Study was amended to reduce IMPT dose in diabetic pts. Conclusions: Preoperative IMPT with selective dose escalation to 63 GyRBE to the high risk posterior RPS margin is feasible. Early local control results with this approach appear promising. Some peri-operative morbidity was noted but appears to be in the expected range for RPS resections. Clinical trial information: NCT01659203.

Abstract The dilemma of whether to treat elderly patients with diffuse large B-cell lymphoma (DLBCL) with a full or reduced dose intensity (DI) of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone+rituximab) is often faced by clinicians. We conducted a systematic review assessing the impact of R-CHOP DI on DLBCL survival outcomes, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) guidelines. We searched MEDLINE, EMBASE, and Cochrane CENTRAL for studies with ≥100 patients treated with R-CHOP/R-CHOP–like therapies published from January 2002 through November 2020. Studies were included if they reported the impact of R-CHOP DI on survival outcomes. We screened records, extracted data, and reviewed all the studies for quality and statistical appraisal. Of 380 screened records, 13 studies including 5188 patients were reviewed. DI was often calculated as the ratio of the cumulative delivered dose of prespecified drug(s) to the cumulative planned dose multiplied by a time-correction factor. Lower DI (intended or relative) was associated with inferior survival in 7 of 9 studies reporting crude survival analyses. Multivariable analysis using DI as a covariate was performed in 10 studies. Six showed an association (P < .05) with adjustment for other covariates, and 4 did not. Most studies and those larger studies of higher quality showed poorer outcomes associated with reduced DI. In subgroups aged ≥80 years, survival was not consistently affected by reduced DI. DI-specific randomized trials are warranted, but these data support full-dose R-CHOP in elderly and fit patients aged <80 years with DLBCL, but not in those aged ≥80 years, where dose-reduced R-CHOP does not appear to compromise survival.

Background. Gaps in our knowledge of long-term outcomes affect decision making for potential living kidney donors. Methods. The Scientific Registry of Transplant Recipients was asked to determine the feasibility of a candidate registry. Results. Ten living kidney donor programs evaluated 2107 consecutive kidney donor candidates; 2099 of 2107 (99.6%) completed evaluations, 1578 of 2099 (75.2%) had a decision, and 790 of 1578 (50.1%) were approved to donate as of March 12, 2020. By logistic regression, candidates most likely to be approved were married or had attended college or technical school; those least likely to be approved had ≥1 of the following characteristics: Black race, history of cigarette smoking, and higher blood pressure, higher triglycerides, or higher urine albumin-to-creatinine ratios. Reasons for 617 candidates not being approved included medical issues other than chronic kidney disease risk (25.3%), chronic kidney disease risk (18.5%), candidate withdrawal (15.2%), recipient reason (13.6%), anatomical risk to the recipient (10.3%), noneconomic psychosocial (10.3%), economic (0.5%), and other reasons (6.4%). Conclusions. These results suggest that a comprehensive living donor registry is both feasible and necessary to assess long-term outcomes that may inform decision making for future living donor candidates. There may be socioeconomic barriers to donation that require more granular identification so that active measures can address inequities. Some candidates who did not donate may be suitable controls for discerning the appropriateness of acceptance decisions and the long-term outcomes attributable to donation. We anticipate that these issues will be better identified with modifications to the data collection and expansion of the registry to all centers over the next several years.

AbstractExcessive activation of the thrombin receptor, protease activated receptor 1 (PAR1) is implicated in diverse neuropathologies from neurodegenerative conditions to neurotrauma. PAR1 knockout mice show improved outcomes after experimental spinal cord injury (SCI), however information regarding the underpinning cellular and molecular mechanisms is lacking. Here we demonstrate that genetic blockade of PAR1 in female mice results in improvements in sensorimotor co‐ordination after thoracic spinal cord lateral compression injury. We document improved neuron preservation with increases in Synapsin‐1 presynaptic proteins and GAP43, a growth cone marker, after a 30 days recovery period. These improvements were coupled to signs of enhanced myelin resiliency and repair, including increases in the number of mature oligodendrocytes, their progenitors and the abundance of myelin basic protein. These significant increases in substrates for neural recovery were accompanied by reduced astrocyte (Serp1) and microglial/monocyte (CD68 and iNOS) pro‐inflammatory markers, with coordinate increases in astrocyte (S100A10 and Emp1) and microglial (Arg1) markers reflective of pro‐repair activities. Complementary astrocyte‐neuron co‐culture bioassays suggest astrocytes with PAR1 loss‐of‐function promote both neuron survival and neurite outgrowth. Additionally, the pro‐neurite outgrowth effects of switching off astrocyte PAR1 were blocked by inhibiting TrkB, the high affinity receptor for brain derived neurotrophic factor. Altogether, these studies demonstrate unique modulatory roles for PAR1 in regulating glial‐neuron interactions, including the capacity for neurotrophic factor signaling, and underscore its position at neurobiological intersections critical for the response of the CNS to injury and the capacity for regenerative repair and restoration of function.