Review: cerebral microvascular pathology in ageing and neurodegeneration.

This review of age-related brain microvascular pathologies focuses on topics studied by this laboratory, including anatomy of the blood supply, tortuous vessels, venous collagenosis, capillary remnants, vascular density and microembolic brain injury. Our studies feature thick sections, large blocks embedded in celloidin, and vascular staining by alkaline phosphatase. This permits study of the vascular network in three dimensions, and the differentiation of afferent from efferent vessels. Current evidence suggests that there is decreased vascular density in ageing, Alzheimer's disease and leukoaraiosis, and cerebrovascular dysfunction precedes and accompanies cognitive dysfunction and neurodegeneration. A decline in cerebrovascular angiogenesis may inhibit recovery from hypoxia-induced capillary loss. Cerebral blood flow is inhibited by tortuous arterioles and deposition of excessive collagen in veins and venules. Misery perfusion due to capillary loss appears to occur before cell loss in leukoaraiosis, and cerebral blood flow is also reduced in the normal-appearing white matter. Hypoperfusion occurs early in Alzheimer's disease, inducing white matter lesions and correlating with dementia. In vascular dementia, cholinergic reductions are correlated with cognitive impairment, and cholinesterase inhibitors have some benefit. Most lipid microemboli from cardiac surgery pass through the brain in a few days, but some remain for weeks. They can cause what appears to be a type of vascular dementia years after surgery. Donepezil has shown some benefit. Emboli, such as clots, cholesterol crystals and microspheres can be extruded through the walls of cerebral vessels, but there is no evidence yet that lipid emboli undergo such extravasation.

A three-dimensional study of brain string vessels using celloidin sections stained with anti-collagen antibodies.

The purpose of this study was to explain the morphology and significance of string vessels in human brains. Brain slices (1.5 cm thick) were embedded in celloidin, sections cut at 100 microm and stained with antibody to collagen IV. A second component of the study was a 3-D rotational study for which we used sections stained with propidium iodide for cell nuclei and anti-collagen stain for blood vessel basement membranes. The materials consisted of brain from two infants at 28 and 35 weeks gestation, two term infants at 20 days and 3 months, one 5 years old, and 3 adults aged 25, 57, and 84 years. String vessels were counted in at least six fields of deep white matter using a 10x objective and the counts averaged and expressed as string vessels per cubic mm. The 3-D rotational study using confocal microscopy was designed to find nuclei in string vessels. The least number of string vessels were present in the premature infant. All others had comparably similar numbers of string vessels except the two term-born infants in whom there was a 3-5-fold increase. However, the two brains had other pathologic lesions, which could affect the counts. In normal brains, string vessels appear as a singe line of stain and usually connect two arterioles or capillaries. They can form loops and occasionally a string vessel may continue into a normal capillary. String vessels have rare nuclei. Our study indicates that string vessels are present in utero, increase in number and are present throughout life. Their exact nature remains unexplained. They apparently do not represent age-related acquired atrophy of capillaries because they are present at all ages and do not progressively increase with normal aging. This technique appears suitable for the study of large number of string vessels.

Cerebrovascular pathology in Alzheimer's disease and leukoaraiosis.

A high percentage of patients with Alzheimer's disease (AD) show evidence of white matter degeneration known as leukoaraiosis (LA), which is due to chronic ischemia. We found that the periventricular veins tend to become occluded by multiple layers of collagen in the vessel walls in the elderly. This collagen deposition is particularly excessive in LA lesions. Therefore, it is present in the brains of many AD patients, along with other ischemia-causing cerebrovascular pathology. We found evidence that there is severe loss of oligodendrocytes in LA, due to extensive apoptosis. No evidence of inflammation was found in the LA lesions. In thick celloidin sections of AD brain, we have obtained detailed 3D views of small (early) deposits of amyloid (stained with beta-amyloid antibody) around capillaries (stained with collagen IV antibody).

Apoptosis in leukoaraiosis.

We report a case of leukoaraiosis that was studied for apoptosis. In the neuropil, the number of cells that showed DNA fragmentation was 2.5 times as great in the area of leukoaraiosis as in the adjacent white matter (P = .004) and 25 times as great as in the nearby cortex (P < .001). Our findings suggest that apoptosis, predominantly of oligodendrocytes, is involved in the pathogenesis of leukoaraiosis. Within the area of leukoaraiosis, we also found numerous small veins that were partially occluded by severe collagenous thickening of the vessel walls. This collagenosis may have contributed to or resulted from chronic ischemia in that area.

In vitro and in vivo localization of prostaglandin H synthase in fetal sheep neurons.

Immunoreactive (IR) prostaglandin H synthase (PGHS) was evident in primary cortical cultures as early as day 2 after seeding. Labeling did not increase with time in culture, nor was there an apparent difference in IR intensity between 2 and 10% serum cultures or between glial and neuronal figures. PGHS-1 IR appeared as a homogeneous cytoplasmic fluorescence compared with PGHS-2 IR which tended to be more intense, particulate and exclusively perinuclear. PGHS-2(+) IR in both neurons and glia increased with time in culture. Immunofluorescence varied in intensity, but no significant degree of variation was seen between cell types. Neuronal PGHS-2 IR extended into processes and amassed in growth cones and at the leading edge processes of astrocytes. Novel rosette formations, possibly lipid bodies, were common in cultured neurons, but not astrocytes.

Inhibitory effects of hypoxia and adenosine on N-methyl-D-aspartate-induced pial arteriolar dilation in piglets.

Our previous studies have indicated that oxygen radicals, produced during reoxygenation following short-term arterial hypoxia, lead to sustained suppression of cerebral arteriolar responses to N-methyl-D-aspartate (NMDA). However, whether arteriolar dilator responses to NMDA are reduced during arterial hypoxia has never been examined. In this study, we determined whether hypoxia or hypoxia-related metabolites such as adenosine or nitric oxide (NO) will reduce NMDA-induced arteriolar dilation. We have also determined the location of NMDA receptor- and brain nitric oxide synthase (bNOS)-positive neurons in the cerebral cortex. In anesthetized piglets, pial arteriolar diameters were determined using intravital microscopy. Baseline arteriolar diameters were approximately 100 microns. Topical application of NMDA at concentrations of 10(-5), 5 x 10(-5) and 10(-4) M resulted in dose-dependent vasodilation (9 +/- 2, 18 +/- 2 and 29 +/- 2% above baseline, respectively, n = 21). Administration of theophylline (20 mg/kg, i.v.) had no effect on NMDA-dependent vasodilation, but it did block dilation to hypoxia (inhalation of 8.5% O2). In theophylline-treated animals, NMDA responses were completely abolished during hypoxia (28 +/- 2 vs. 2 +/- 1%, respectively to 10(-4) M, n = 7) while sodium nitroprusside (SNP, 10(-4) M) still dilated pial arterioles normally. NMDA-induced vasodilation was not modified after application and removal of adenosine (10(-4) M; n = 5) or SNP (10(-5) M; n = 4), or when SNP (10(-7) M) was coapplied with NMDA (n = 6). Conversely, coapplication of adenosine (10(-6) M) attenuated NMDA responses (31 +/- 5 vs. 20 +/- 3%, n = 7). We also found that NMDA receptor- and bNOS-containing neurons were located predominantly in layers II/III of the cortex. Proximity of these neurons to the cortical surface is consistent with diffusion of NO to pial arterioles as the mechanism of dilation to NMDA. We conclude that NMDA-induced cerebral arteriolar dilation is inhibited by hypoxia alone and by exogenous adenosine, but not by NO.

Immunofluorescent localization of constitutive and inducible prostaglandin H synthase in ovine astroglia.

We have used immunofluorescent techniques to examine the distribution of prostaglandin H synthase (PGHS) in ovine astrocyte-enriched secondary cultures and in mixed cortical cells in primary culture. A battery of monoclonal and polyclonal antibodies specific for the constitutive (PGHS-1) or inducible (PGHS-2) forms of the enzyme were used to examine the cells in culture. Varying levels of PGHS-1 and PGHS-2-specific immunofluorescence were seen in astrocytes as well as in other cells. The fluorescent pattern and localization seen with antisera to both PGHS-1 and PGHS-2 were similar but were not identical. Both immunoreactive species were confined to nuclear and perinuclear regions of the cell, with no immunoreactivity evident in plasmalemma. In addition, PGHS-2-specific fluorescence was concentrated often as a homogeneous ring around the nucleus in heavily stained astrocytes. Mixed cortical glia/fibroblasts in primary culture were double labeled with antibodies to glial fibrillary acidic protein (GFAP) and to PGHS-2. GFAP and PGHS-2 were colocalized in clusters of astrocytes, but PGHS-2 was evident in GFAP- cells as well. Cells treated with the mitogenic agent phorbol dibutyrate displayed more PGHS-2+ immunofluorescence compared to either vehicle control or cells pretreated with dexamethasone. We conclude that astrocytes cultured in serum express both constitutive and inducible forms of PGHS and that PGHS-2 is induced by mitogens in this cell type.

Phorbol ester-induced prostaglandin production in piglet cortical astroglia.

We examined effects of phorbol 12,13-dibutyrate (PDB), which activates protein kinase C (PKC), on prostaglandin and leukotriene production in piglet cultured glia derived from cerebral cortex and white matter. Levels of prostaglandins were determined using enzyme immunoassay. Baseline levels in media for prostaglandin F2 alpha (PGF2 alpha) were 730 +/- 116 pg/ml and increased to 1,551 +/- 196 pg/ml at 10(-8) M PDB (P < 0.05) and to 2,182 +/- 190 pg/ml at 10(-6) M PDB (P < 0.05) (n = 16). Little or no 6-keto-prostaglandin F1 alpha, prostaglandin E2, or leukotrienes C4/D4 were produced. PGF2 alpha levels in media did not increase in the presence of the vehicle for PDB (dimethyl sulfoxide) or 4 alpha-phorbol 12,13-didecanoate (PDD; a phorbol ester that does not activate protein kinase C) or when indomethacin (10 micrograms/ml), quinacrine (10(-6) M), or isoquinolinylsulfonylmethyl piperazine (10(-4) M) (an inhibitor of PKC activation) was coadministered with PDB. We conclude that glia can be important contributors of prostaglandins to extracellular-cerebrospinal fluids where they could influence cerebrovascular tone, and that PDB probably increases prostaglandin production via liberation of arachidonic acid by PKC-induced activation of phospholipase A2.

Excitotoxin paraventricular nucleus lesions: stress and endocrine reactivity and oxytocin mRNA levels.

Electrolytic lesion of the paraventricular nucleus (PVN) of the hypothalamus blocks the tachycardia response to stress. The current study examined the effects of chemical lesion of PVN parvocellular neurons on the cardiovascular and endocrine responses to stress and on the content of hypothalamic oxytocin (OT) mRNA levels. Acute footshock stress increased heart rate in both ibotenic acid lesion and control groups of animals; however, the tachycardia was significantly lower in animals with a PVN lesion than the controls. Lesion of the PVN also attenuated the increase in plasma OT induced by stress, 4-fold in the lesion group versus 20-fold for the controls. There was not a generalized decrease in hormonal responsiveness since the OT response to an osmotic challenge was exaggerated in the lesion group. There was no difference between the groups in the arterial pressure and vasopressin responses to acute stress. Neurotoxin lesions of the PVN also resulted in significant depletions of VP and OT in all levels of the spinal cord and decreased OT levels in the dorsal brainstem. Ibotenic acid lesions of the PVN resulted in no significant changes in OT mRNA in the PVN, SON and PP. In addition, the 48-h dehydration resulted in a significant increase in plasma OT and OT mRNA in the PVN. These data indicate that the parvocellular neurons of the PVN play a role in integration of cardiovascular and endocrine responses to both stressful and osmotic stimuli and provide further evidence that parvocellular OT and VP neurons project to the brainstem and spinal cord.