Assessment of associations between neutrophil extracellular trap biomarkers in blood and thrombi in acute ischemic stroke patients.

Inflammation including immunothrombosis by neutrophil extracellular traps (NETs) has important implications in acute ischemic stroke and can affect reperfusion status, susceptibility to stroke associated infections (SAI) as well as functional clinical outcome. NETs were shown to be prevalent in stroke thrombi and NET associated markers were found in stroke patients' blood. However, little is known whether blood derived NET markers reflect the amount of NETs in thrombi. Conclusions from blood derived markers to thrombus composition might open avenues for novel strategies in diagnostic and therapeutic approaches. We prospectively recruited 166 patients with acute ischemic stroke undergoing mechanical thrombectomy between March 2018 and May 2021. Available thrombi (n = 106) were stained for NET markers DNA-histone-1 complexes and myeloperoxidase (MPO). Cell free DNA (cfDNA), deoxyribonuclease (DNase) activity, MPO-histone complexes and a cytokine-panel were measured before thrombectomy and after seven days. Clinical data, including stroke etiology, reperfusion status, SAI and functional outcome after rehabilitation, were collected of all patients. NET markers were present in all thrombi. At onset the median concentration of cfDNA in blood was 0.19 µg/ml increasing to 0.30 µg/ml at 7 days. Median DNase activity at onset was 4.33 pmol/min/ml increasing to 4.96 pmol/min/ml at 7 days. Within thrombi DNA-histone-1 complexes and MPO correlated with each other (ρ = 0.792; p < 0.001). Moreover, our study provides evidence for an association between the amount of NETs and endogenous DNase activity in blood with amounts of NETs in cerebral thrombi. However, these associations need to be confirmed in larger cohorts, to investigate the potential clinical implications for individualized therapeutic and diagnostic approaches in acute ischemic stroke.

Metric information in cognitive maps: Euclidean embedding of non-Euclidean environments.

The structure of the internal representation of surrounding space, the so-called cognitive map, has long been debated. A Euclidean metric map is the most straight-forward hypothesis, but human navigation has been shown to systematically deviate from the Euclidean ground truth. Vector navigation based on non-metric models can better explain the observed behavior, but also discards useful geometric properties such as fast shortcut estimation and cue integration. Here, we propose another alternative, a Euclidean metric map that is systematically distorted to account for the observed behavior. The map is found by embedding the non-metric model, a labeled graph, into 2D Euclidean coordinates. We compared these two models using data from a human behavioral study where participants had to learn and navigate a non-Euclidean maze (i.e., with wormholes) and perform direct shortcuts between different locations. Even though the Euclidean embedding cannot correctly represent the non-Euclidean environment, both models predicted the data equally well. We argue that the embedding naturally arises from integrating the local position information into a metric framework, which makes the model more powerful and robust than the non-metric alternative. It may therefore be a better model for the human cognitive map.

Gateway identity and spatial remapping in a combined grid and place cell attractor.

The spatial specificities of hippocampal place cells, i.e., their firing fields, are subject to change if the rat enters a new compartment in the experimental maze. This effect is known as remapping. It cannot be explained from path integration (grid cell activity) and local sensory cues alone but requires additional knowledge of the different compartments in the form of context recognition at the gateways between them. Here we present a model for the hippocampal-entorhinal interplay in which the activity of place and grid cells follows a joint attractor dynamic. Place cells depend on the current grid cell activity but can also reset the grid cell activity in the remapping process. Remapping is triggered by the passage through a gateway. When this happens, a previously stored pattern of place cell activity associated with the gateway is reactivated from a "gateway database". The joint attractor will then reinstate the grid cell pattern that was active when the gateway had first been learned and path integration can proceed from there. The model is tested with various mazes used in the experimental literature and reproduces the published results, and we make predictions for remapping in a new maze type. We propose the involvement of memory in the form of "gate cells" that drive the place cells and with them the joint hippocampal-entorhinal loop into the corresponding attractor whenever a compartment is entered.

Insights Into Immunothrombotic Mechanisms in Acute Stroke due to Vaccine-Induced Immune Thrombotic Thrombocytopenia.

During the COVID-19 pandemic, vaccination is the most important countermeasure. Pharmacovigilance concerns however emerged with very rare, but potentially disastrous thrombotic complications following vaccination with ChAdOx1. Platelet factor-4 antibody mediated vaccine-induced immune thrombotic thrombocytopenia (VITT) was described as an underlying mechanism of these thrombotic events. Recent work moreover suggests that mechanisms of immunothrombosis including neutrophil extracellular trap (NET) formation might be critical for thrombogenesis during VITT. In this study, we investigated blood and thrombus specimens of a female patient who suffered severe stroke due to VITT after vaccination with ChAdOx1 in comparison to 13 control stroke patients with similar clinical characteristics. We analyzed cerebral thrombi using histological examination, staining of complement factors, NET-markers, DNase and LL-37. In blood samples at the hyper-acute phase of stroke and 7 days later, we determined cell-free DNA, myeloperoxidase-histone complexes, DNase activity, myeloperoxidase activity, LL-37 and inflammatory cytokines. NET markers were identified in thrombi of all patients. Interestingly, the thrombus of the VITT-patient exclusively revealed complement factors and high amounts of DNase and LL-37. High DNase activity was also measured in blood, implying a disturbed NET-regulation. Furthermore, serum of the VITT-patient inhibited reactive oxygen species-dependent NET-release by phorbol-myristate-acetate to a lesser degree compared to controls, indicating either less efficient NET-inhibition or enhanced NET-induction in the blood of the VITT-patient. Additionally, the changes in specific cytokines over time were emphasized in the VITT-patient as well. In conclusion, insufficient resolution of NETs, e.g. by endogenous DNases or protection of NETs against degradation by embedded factors like the antimicrobial peptide LL-37 might thus be an important factor in the pathology of VITT besides increased NET-formation. On the basis of these findings, we discuss the potential implications of the mechanisms of disturbed NETs-degradation for diagnostic and therapeutic approaches in VITT-related thrombogenesis, other auto-immune disorders and beyond.