Journal of Cerebral Blood Flow & Metabolism

Ischemic stroke results in sudden blood flow cessation, thus, unmet energy requirements. Although the clotted artery can be recanalized and blood flow is restored, brain perfusion may not be fully attained due to microvascular constrictions. Under glucose deprived and hypoxic conditions, glucose derived from the glycogen stored around peri-microvascular astrocyte end-feet may serve as an emergency fuel to meet the metabolic demand during acute period of ischemic stroke. To elucidate the impact of glycogen utilization on brain microcirculation, we administered glycogen phosphorylase inhibitor 1,4-dideoxy-1,4-imino-d-arabinitol (DAB) intracerebroventricularly. Transgenic mice in which glycogen synthase-1 expression was selectively knocked out in central nervous system (GYS1Nestin-KO) were also used. Both approaches caused microvascular constrictions mediated by CD13-positive pericyte contractions. When mice with disrupted glycogen utilization were subjected to MCA ischemia, pericyte-mediated microvascular constrictions and the infarct volumes were further increased compared to untreated controls or wild type littermates. Perimicrovascular glycogen depletions were highly correlated with microvascular constrictions as shown by Periodic acid Schiff (PAS) staining and immunolabeling with anti-glycogen antibodies. Imaging of regional cortical blood flow changes during ischemia disclosed severely compromised blood flow dynamics in mice with disrupted glycogen metabolism. In conclusion, disrupting glycogen utilization causes ischemic-like microvascular constrictions under non-ischemic circumstances and increases susceptibility to brain ischemia. Understanding the role of glycogen at neurogliovascular level in brain may provide novel insight to the pathophysiology of ischemic stroke and therapeutic opportunities. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=142 SRC="FIGDIR/small/505172v1_ufig1.gif" ALT="Figure 1"> View larger version (33K): org.highwire.dtl.DTLVardef@1a4972borg.highwire.dtl.DTLVardef@c09847org.highwire.dtl.DTLVardef@4d961forg.highwire.dtl.DTLVardef@1bae0de_HPS_FORMAT_FIGEXP M_FIG C_FIG

AbstractType 2 diabetes mellitus (T2DM) is associated with impaired leptomeningeal collateral compensation and poor stroke outcome. Neutrophils tethering and rolling on endothelium after stroke can also independently reduce flow velocity. However, the chronology and topological changes in collateral circulation in T2DM is not yet defined. Here, we describe the spatial and temporal blood flow dynamics and vessel remodeling in pial arteries and veins and leukocyte- endothelial adhesion following middle cerebral artery (MCA) stroke using two-photon microscopy in awake control and T2DM mice. Relative to control mice prior to stroke, T2DM mice already exhibited smaller pial vessels with reduced flow velocity. Following stroke, T2DM mice displayed persistently reduced blood flow in pial arteries and veins, resulting in a poor recovery of downstream penetrating arterial flow and a sustained deficit in microvascular flow. There was also persistent increase of leukocyte adhesion to the endothelium of veins, coincided with elevated neutrophils infiltration into brain parenchyma in T2DM mice compared to control mice after stroke. Our data suggest that T2DM-induced increase in chronic inflammation may contribute to the remodeling of leptomeningeal collateral circulation and the observed hemodynamics deficiency that potentiates poor stroke outcome. HighlightsO_LIBlood flow and leukocyte imaging in awake mice by two-photon microscopy before and after stroke under physiological conditions C_LIO_LIT2DM induces collateral remodeling prior to stroke C_LIO_LIT2DM reduces blood flow and impedes recovery in pial arteries and veins after ischemic stroke C_LIO_LIPoor recovery of penetrating arterial flow and sustained deficit in microvascular flow after ischemic stroke in T2DM mice C_LIO_LIT2DM increases persistent leukocyte adhesion to endothelium of veins and elevates neutrophils infiltration into the brain parenchyma after ischemic stroke. C_LI

IntroductionCerebral microangiopathy often manifests as white matter hyperintensities (WMH) on T2-weighted MR images and is associated with elevated stroke risk. Large vessel steno-occlusive disease (SOD) is also independently associated with stroke risk, however, the interaction of microangiopathy and SOD is not well understood. Cerebrovascular reactivity (CVR) describes the capacity of cerebral circulation to adapt to changes in perfusion pressure and neurovascular demand, and its impairment portends future infarctions. CVR can be measured with blood oxygen level dependent (BOLD) imaging following acetazolamide stimulus (ACZ-BOLD). We studied CVR differences between WMH and normal-appearing white matter (NAWM) in patients with chronic SOD, hypothesizing additive influences upon CVR measured by novel, fully dynamic CVR maxima (CVRmax). MethodsA cross sectional study was conducted to measure per-voxel, per-TR maximal CVR (CVRmax) using a custom computational pipeline in 23 subjects with angiographically-proven unilateral SOD. WMH and NAWM masks were applied to CVRmaxmaps. White matter was subclassified with respect to the SOD-affected hemisphere, including: i. contralateral NAWM; ii. contralateral WMH iii. ipsilateral NAWM; iv. ipsilateral WMH. CVRmax was compared between these groups with a Kruskal-Wallis test followed by a Dunn-Sidak post-hoc test for multiple comparisons. Results19 subjects (age 50{+/-}12 years, 53% female) undergoing 25 examinations met criteria. WMH volume was asymmetric in 16/19 subjects with 13/16 exhibiting higher volumes ipsilateral to SOD. Pairwise comparisons of CVRmaxbetween groups was significant with ipsilateral WMH CVRmax lower than contralateral NAWM (p=0.015) and contralateral WMH (p=0.003) when comparing in-subject medians and lower than all groups when comparing pooled voxelwise values across all subjects (p<0.0001). No significant relationship between WMH lesion size and CVRmax was detected. ConclusionOur results suggest additive effects of microvascular and macrovascular disease upon white matter CVR, but with greater overall effects relating to macrovascular SOD than to apparent microangiopathy. Dynamic ACZ-BOLD presents a promising path towards a quantitative stroke risk imaging biomarker. BACKGROUNDCerebral white matter (WM) microangiopathy manifests as sporadic or sometimes confluent high intensity lesions in MR imaging with T2-weighting, and bears known associations with stroke, cognitive disability, depression and other neurological disorders1-5. Deep white matter is particularly susceptible to ischemic injury owing to the deprivation of collateral flow between penetrating arterial territories, and hence deep white matter hyperintensities (WMH) may portend future infarctions6-8. The pathophysiology of WMH is variable but commonly includes a cascade of microvascular lipohyalinosis and atherosclerosis together with impaired vascular endothelial and neurogliovascular integrity, leading to blood brain barrier dysfunction, interstitial fluid accumulation, and eventually tissue damage9-14. Independent of the microcirculation, cervical and intracranial large vessel steno-occlusive disease (SOD) often results from atheromatous disease and is associated with increased risk of stroke owing to thromboembolic phenomena, hypoperfusion, or combinations thereof15-17. White matter disease is more common in the affected hemisphere of patients with asymmetric or unilateral SOD, producing both macroscopic WMH detectable by routine structural MRI, as well as microstructural changes and altered structural connectivity detected by advanced diffusion microstructural imaging18, 19. An improved understanding of the interaction of microvascular disease (i.e., WMH) and macrovascular steno-occlusion could better inform stroke risk stratification and guide treatment strategies when coexistent. Cerebrovascular reactivity (CVR) is an autoregulatory adaptation characterized by the capacity of the cerebral circulation to respond to physiological or pharmacological vasodilatory stimuli20-22. CVR may be heterogeneous and varies across tissue type and pathological states1, 16. Alterations in CVR are associated with elevated stroke risk in SOD patients, although white matter CVR, and in particular the CVR profiles of WMH, are only sparsely studied and not fully understood1, 23-26. We have previously employed blood oxygen level dependent (BOLD) imaging following a hemodynamic stimulus with acetazolamide (ACZ) in order to measure CVR (i.e. ACZ-BOLD)21, 27, 28. Despite the emergence of ACZ-BOLD as a technique for clinical and experimental use, poor signal-to-noise characteristics of the BOLD effect have generally limited its interpretation to coarse, time-averaged assessment of the terminal ACZ response at arbitrarily prescribed delays following ACZ administration (e.g. 10-20 minutes)29. More recently, we have introduced a dedicated computational pipeline to overcome historically intractable signal-to-noise ratio (SNR) limitations of BOLD, enabling fully dynamic characterization of the cerebrovascular response, including identification of previously unreported, unsustained or transient CVR maxima (CVRmax) following hemodynamic provocation27, 30. In this study, we compared such dynamic interrogation of true CVR maxima between WMH and normal appearing white matter (NAWM) among patients with chronic, unilateral SOD in order to quantify their interaction and to assess the hypothesized additive effects of angiographically-evident macrovascular stenoses when intersecting microangiopathic WMH.

The goal of this study was to evaluate changes in metabolic homeostasis during the first 12 weeks of recovery in a distal middle cerebral artery occlusion mouse model of stroke. To achieve this goal, we compared the brain metabolomes of ipsilateral and contralateral hemispheres from aged male mice up to 12 weeks after stroke to that of age-matched naive and sham operated mice. There were 707 biochemicals detected in each sample by liquid chromatography-mass spectroscopy (LC-MS). Mitochondrial fatty acid {beta}-oxidation, indicated by acyl carnitine levels, was increased in stroked tissue at 1 day and 4 weeks following stroke. Glucose and several glycolytic intermediates were elevated in the ipsilateral hemisphere for 12 weeks compared to the aged naive controls, but pyruvate was decreased. Additionally, itaconate, a glycolysis inhibitor associated with activation of anti-inflammatory mechanisms in myeloid cells, was higher in the same comparisons. These changes correlated with reduced levels of glutamate, dopamine, and adenosine in the ipsilateral hemisphere after stroke. These results indicate that chronic metabolic differences exist between stroked and control tissue, including alterations in fatty acid metabolism and glycolysis for at least 12 weeks after stroke.

Despite the pivotal role of pial collaterals in maintaining cerebral blood flow during focal brain ischemia, it is largely unexplored how the microvascular blood flow and oxygenation in the watershed "pial-collateral territory" differ from those in the territory supplied by the major arteries during chronic global hypoperfusion. To answer this question, we applied 2-photon microscopy and Doppler optical coherence tomography to investigate the changes in cerebral microvascular blood flow and partial pressure of oxygen (PO2), induced by bilateral common carotid artery stenosis (BCAS). The measurements were performed in the somatosensory cortex that is supplied by the middle cerebral artery (MCA), and in the adjacent watershed area in the awake, head-restrained C57BL/6 mice, via the chronic cranial window. The results showed that the BCAS induced a larger decrease in capillary red blood cell (RBC) flux in the watershed area than in the MCA territory, especially in the subcortical white matter. Besides, PO2 in the pial collaterals was significantly lower than that in the upstream MCA segments under control conditions. However, the PO2 changes in the arteries and veins under global hypoperfusion displayed different trends in the two interrogated regions, resulting in a significant increase in oxygen extraction fraction in the watershed area. These findings suggest a mismatch between oxygen supply and demand in the watershed area due to global hypoperfusion and increased subcortical white matter vulnerability. We have also observed dilation of the pial collaterals after BCAS, which might suggest a compensatory mechanism to improve the blood flow in the watershed under hypoperfusion.

Acute ischemic stroke (AIS) is a frequent cause of death and adult disability. AIS patient management targets the ischemic penumbra: Hypoperfused, electrically silent brain tissue, which can be salvaged by restoring blood flow during the first, critical hours after symptom onset. Neuroimaging studies in AIS patients suggest that penumbral tissue is characterized not only by hypoperfusion, but also by microvascular flow disturbances that strongly affect tissue outcome. Here, we demonstrate that microvascular flows become increasingly chaotic in the ischemic penumbra in the hours after middle cerebral artery occlusion in a rat model of AIS. Biophysical models suggest that these disturbances are accompanied by increasing hypoxia in the absence of blood flow changes. Unlike findings in severe ischemia, pericyte constrictions do not appear to occlude penumbral capillaries. We propose that microvascular flow disturbances represent a critical feature of penumbral tissue, and a potential target for neuroprotective therapy after AIS.

AO_SCPLOWBSTRACTC_SCPLOWSorCS2 is involved in trafficking of membrane receptors and transporters. SorCS2 is implicated in brain disorders, but the mechanism remains uncertain. We hypothesized that SorCS2 expression is important for neurovascular coupling. Brains from P8 and 2-month-old wild type mice were stained for SorCS2 and compared to SorCS2 knockouts (Sorcs2-/-). Changes in cerebral perfusion in response to sensory stimulation, i.e., neurovascular coupling, were compared in vivo. Neurovascular coupling was also assessed ex vivo in brain slices loaded with calcium-sensitive dye. Proteomics of astrocytes was analyzed for ingenuity pathways. SorCS2 was strongly expressed in astrocytic endfeet of P8 mice but only in few astrocytes from 2-month-old brains. Sorcs2-/- mice demonstrated reduced neurovascular coupling. This was associated with reduced astrocytic calcium response to neuronal excitation in Sorcs2-/- mice. No difference in cerebral artery caliber nor in endothelial function was seen between wild type and Sorcs2-/- mice. Proteomics indicated reduced glutamatergic signaling and suppressed calcium signaling in Sorcs2-/- astrocytes. We suggest that SorCS2 expression is important for neurovascular coupling due to modulation of glutamatergic and calcium signaling in astrocytes.

BackgroundBrain perivascular spaces (PVS) are part of the glymphatic system and facilitate clearance of metabolic byproducts. Since enlarged PVS are associated with vascular health, we tested whether intensive systolic blood pressure (SBP) treatment affects PVS structure. MethodsThis is a secondary analysis of the Systolic PRessure INTervention (SPRINT) Trial MRI Substudy: a randomized trial of intensive SBP treatment to goal < 120 mm Hg vs. < 140 mm Hg. Participants had increased cardiovascular risk, pre-treatment SBP 130-180, and no clinical stroke, dementia, or diabetes. Brain MRIs acquired at baseline and follow-up were used to automatically segment PVS in the supratentorial white matter and basal ganglia using a Frangi filtering method. PVS volumes were quantified as a fraction of the total tissue volume. The effects of SBP treatment group and major antihypertensive classes on PVS volume fraction were separately tested using linear mixed-effects models while covarying for MRI site, age, sex, black race, baseline SBP, history of cardiovascular disease (CVD), chronic kidney disease, and white matter hyperintensities (WMH). ResultsFor 610 participants with sufficient quality MRI at baseline (mean age 67{+/-}8, 40% female, 32% black), greater PVS volume fraction was associated with older age, male sex, non-Black race, concurrent CVD, WMH, and brain atrophy. For 381 participants with MRI at baseline and at follow-up (median = 3.9 years), intensive treatment was associated with decreased PVS volume fraction relative to standard treatment (interaction coefficient: -0.029 [-0.055 to -0.0029] p=0.029). Reduced PVS volume fraction was also associated with exposure to calcium channel blockers (CCB) and diuretics. ConclusionsIntensive SBP lowering partially reverses PVS enlargement. The effects of CCB use suggests that improved vascular compliance may be partly responsible. Improved vascular health may facilitate glymphatic clearance. Clincaltrials.gov: NCT01206062

BackgroundQuantitative cerebral blood flow (CBF) measured with [15O]water positron emission tomography (PET) is the reference standard for quantifying brain perfusion. However, clinical interpretation of individual CBF measurements is limited by the absence of large normative datasets accounting for physiological variability across the adult lifespan. Long-axial field-of-view PET enables high-sensitivity quantitative [15O]water perfusion imaging without arterial blood sampling, allowing normative characterization of cerebral perfusion at unprecedented scale. The aim of this study was to establish normative and covariate-adjusted models of cerebral blood flow across the adult lifespan using total-body [15O]water PET. MethodsQuantitative CBF measurements were obtained in 302 neurologically healthy adults (age 21-86 years) using total-body [15O]water PET. Linear mixed-effects models were used to evaluate the effects of age, sex, body mass index (BMI), and blood hemoglobin concentration on CBF and to generate normative prediction models across the adult lifespan. Between-subject and within-subject variability were estimated from repeated scans in a subset of participants (n=51). ResultsMean grey matter CBF was 46.1 mL/(min*dL), with substantial inter-individual variability but high within-subject reproducibility (intraclass correlation coefficients 0.78-0.89). Advancing age was associated with a decline in CBF of approximately 7% per decade (p_FDR < 10-12). Higher BMI was associated with lower CBF (approximately -6% per 10 kg/m2; p_FDR < 0.01). Women exhibited higher CBF than men (approximately 7.5%), but this difference was largely explained by lower blood hemoglobin concentration in women. Covariate-adjusted models were used to generate normative predictions and prediction intervals describing expected CBF across adulthood. ConclusionThis study establishes a normative database of quantitative cerebral blood flow across the adult lifespan using high-sensitivity [15O]water PET. Age, BMI, and hemoglobin are major determinants of inter-individual variability in CBF. The resulting generative models provide a quantitative reference framework for interpreting cerebral perfusion measurements and may enable automated detection of abnormal brain perfusion in clinical PET imaging.

Ketosis is known to alter the balance of neuroactive amino acids and enhance neural function when compared to a glycolytic condition. However, its influence on other metabolites, such as antioxidants and neural energy markers, and the mechanisms by which ketosis improves neural function remain unclear. Here, we measure the neurochemical effects of acute ketosis on the human brain using ultra-high-field 1H MR Spectroscopy (MRS) and investigate the subsequent impact on neural function through resting-state functional magnetic resonance imaging (rsfMRI). In a within-subjects design, N = 63 healthy adults from across the lifespan underwent 1H MRS and rsfMRI scans before and after consuming individually weight-dosed and calorically-matched ketone monoester or glucose drinks. Ketone monoester administration, but not glucose, significantly elevated cerebral antioxidants and energy markers while decreasing GABA, glutamate, and glutamine levels in the posterior cingulate cortex (PCC). Notably, increased bioenergetics, specifically an increase in total creatine, correlated with greater improvements in neural function as measured using rsfMRI. Our results integrate metabolic and functional neuroimaging findings, offering a comprehensive understanding of ketosis-induced changes in brain chemistry and functional network dynamics, yielding valuable insights into potential mechanisms by which ketosis imparts its neural benefits.

Coronary artery disease increases risk of cognitive decline and stroke and is associated with white matter alterations. However, the biological basis of these changes remains unclear. Myelin content and iron deposition are crucial measures of white matter health and can be measured with quantitative MRI. This study investigated whether myelin and iron alterations occur in coronary artery disease, and their relationship with cognition. In this cross-sectional study, 46 individuals with coronary artery disease and 40 healthy controls aged > 50 years, with normal cognition underwent 3T MRI and cognitive assessments. Quantitative MRI metrics (susceptibility, magnetization transfer saturation, R2* and R1 relaxation rates) were calculated in the border zones between adjacent arterial territories (watershed regions) and in the areas outside these borders (non-watershed regions). Relative to controls, the coronary artery disease group showed lower myelin and higher iron content, as measured by lower magnetization transfer saturation and R1, and higher susceptibility specifically in watershed regions. Importantly, these microstructural alterations were associated with poorer cognitive performance in the coronary artery disease group with lower magnetization transfer and R1related to poorer global cognition and with higher magnetic susceptibility with poorer verbal memory. These findings suggest that coronary artery disease is associated with demyelination and iron deposition in white matter, most prominently in watershed regions, which are known for their susceptibility to stroke. The association of these microstructural alterations with cognition highlights the role of white matter as a key vulnerable region and a promising focus for future mechanistic and therapeutic studies.

We investigated dynamic changes in nicotinamide adenine dinucleotide (NAD{square}) metabolism in the human occipital lobe using ultra-high field 31P functional magnetic resonance spectroscopy (fMRS) at 7 Tesla. Twenty-five healthy volunteers (mean age 24 {+/-} 4 years, 10 female) performed a visual task alternating between fixation and flashing checkerboard stimuli. 31P MRS spectra were acquired from a visual cortex voxel functionally localized by prior fMRI. Linear mixed-effects modelling revealed a significant reduction in NAD{square} concentrations during the first stimulation block, while no significant change was observed during the second block. No significant changes were observed for other high-energy phosphate metabolites (ATP, phosphocreatine, and inorganic phosphate), indicating specificity in the NAD{square} response. Exploratory analyses, dividing the blocks in two halves, suggested further reductions in NAD{square} and tNAD in the second halves of both stimulation blocks, though these trends were not statistically significant. Our findings demonstrate the feasibility of using fMRS at 7T to detect stimulus-induced dynamics in cerebral NAD{square} metabolism in vivo, providing insights into the interplay between glycolysis and oxidative phosphorylation during neural activation.

BackgroundMoyamoya disease (MMD) is a non-atherosclerotic intracranial steno-occlusive condition placing patients at high risk for ischemic stroke. Direct and indirect surgical revascularization can improve blood flow in MMD; however, randomized trials demonstrating efficacy have not been performed and biomarkers of parenchymal hemodynamic impairment are needed to triage patients for interventions and evaluate post-surgical efficacy. We test the hypothesis that hypercapnia-induced maximum cerebrovascular reactivity (CVRMAX) and the more novel indicator cerebrovascular reactivity (CVR) response time (CVRDELAY), both assessed from time-regression analyses of non-invasive hypercapnic imaging, correlate with recent focal ischemic symptoms. MethodsHypercapnic reactivity medical resonance imaging (blood oxygenation level-dependent; echo time=35ms; spatial resolution=3.5x3.5x3.5mm) and catheter angiography assessments of cortical reserve capacity and vascular patency, respectively, in MMD participants (n=73) were performed in sequence. Time regression analyses were applied to quantify CVRMAX and CVRDELAY. Symptomatology information for each hemisphere (n=109) was categorized into symptomatic (ischemic symptoms within six months) or asymptomatic (no history of ischemic symptoms) and logistic regression analysis assessed the association of CVR metrics with ischemic symptoms after controlling for age and sex. ResultsSymptomatic hemispheres displayed lengthened CVRDELAY (p<0.001), which was more discriminatory between hemispheres than CVRMAX (p=0.037). CVRDELAY (p<0.001), but not CVRMAX (p=0.127), was found to be sensitively related to age in asymptomatic tissue (0.33-unit increase/year); age-dependent normative ranges are presented to enable quantitative assessment of patient-specific impairment. Furthermore, the area under the receiver operating characteristic curves shows that CVRDELAY predicts ischemic symptoms (p<0.001), whereas CVRMAX does not (p=0.056). ConclusionFindings support that CVR metrics are uniquely altered in hemispheres with recent ischemic symptoms, motivating the investigation of CVR as a surrogate of ischemic symptomatology and treatment efficacy.

The brain vasculature supplies neurons with glucose and oxygen, but little is known about how vascular plasticity contributes to brain function. Using longitudinal in vivo imaging, we reported that a substantial proportion of blood vessels in the adult brain sporadically occluded and regressed. Their regression proceeded through sequential stages of blood-flow occlusion, endothelial cell collapse, relocation or loss of pericytes, and retraction of glial endfeet. Regressing vessels were found to be widespread in mouse, monkey and human brains. Both brief occlusions of the middle cerebral artery and lipopolysaccharide-mediated inflammation induced an increase of vessel regression. Blockage of leukocyte adhesion to endothelial cells alleviated LPS-induced vessel regression. We further revealed that blood vessel regression caused a reduction of neuronal activity due to a dysfunction in mitochondrial metabolism and glutamate production. Our results elucidate the mechanism of vessel regression and its role in neuronal function in the adult brain.

The continuous supply of glucose and oxygen is essential for healthy brain function. Accordingly, the Selfish Brain Theory proposes that the human brain prioritizes its own energy demands, making it less vulnerable to fluctuations in systemic energy availability. Although studies have reported decreases in cerebral glucose metabolism, alternative energy sources other than glucose might be oxidized for ATP production. However, cerebral oxygen metabolism (CMRO2) has never been quantified across the human brain. In this study, we investigated the influence of insulin-induced hypoglycemia on CMRO2 in healthy male participants. Additionally, we explored the prolonged effects of hypoglycemia on cognitive function following the restoration of euglycemia. We found that CMRO2 remained stable under hypoglycemia, even at blood glucose levels below 49 mg/dL. Interestingly, we detected a significant increase in cerebral blood flow (CBF) of up to 11%, particularly in regions involved in higher cognitive processing. Despite stable rates of oxygen metabolism, we identified a selective impairment in memory consolidation following hypoglycemia, even after normal glucose levels were restored, with no effects observed in memory encoding or attention. In favor of the Selfish Brain Theory, the stability in CMRO2 suggests that the brain efficiently shifts to alternate energy pathways under hypoglycemia, potentially using astrocytic glycogen. Despite this metabolic flexibility, our results indicate that prior hypoglycemia imposes long-lasting effects on memory consolidation, possibly linked to glycogen depletion and impaired glutamate synthesis. In summary, our study suggests that clinical states of hypoglycemia pose a critical impact on patient brain health and functioning.

BACKGROUNDSteno-occlusive diseases of the internal carotid artery (ICA) or middle cerebral artery (MCA) can lead to hemodynamic impairment, yet conventional imaging often fails to reflect metabolic dysfunction. Integrated positron emission tomography and magnetic resonance imaging (PET/MRI) allows simultaneous assessment of cerebral blood flow (CBF) and glucose metabolism. This study compared baseline perfusion and metabolic characteristics between patients receiving medical therapy or extracranial-intracranial (EC-IC) bypass surgery. METHODSThis retrospective study enrolled 34 patients with unilateral ICA/MCA stenosis or occlusion confirmed by digital subtraction angiography. All patients underwent 18F-FDG PET/MRI before treatment. Glucose metabolism was quantified using the cerebral metabolic rate of glucose (CMRGlu) from dynamic PET and the standard uptake value ratio (SUVR) from static PET. CBF was measured using three-dimensional arterial spin labeling with post-labeling delays of 2.0 and 2.5 seconds. Perfusion and metabolic parameters were compared across vascular territories. RESULTSBaseline clinical characteristics and long-term outcomes did not differ between groups (all P>0.05). Cerebral blood flow was similar across all arterial territories and post-labeling delays, with no hemispheric asymmetry detected (all P>0.05). In contrast, glucose metabolism was significantly lower in the surgical group, with reduced CMRGlu in the ischemic middle cerebral artery (23.58{+/-}7.46 vs 18.82{+/-}5.04mol/100g-1/min-1, P=0.037) and anterior cerebral artery territories (26.37{+/-}8.76 vs 20.71{+/-}5.78mol/100g-1/min-1, P=0.034). No differences were observed in the posterior cerebral artery or in SUVR across all regions (all P>0.05). CONCLUSIONSDespite similar perfusion profiles, the surgical group demonstrated lower glucose metabolism, suggesting that metabolic imaging may aid in identifying patients who could benefit from revascularization.

Background and PurposeSubarachnoid hemorrhage (SAH) triggers a complex immune response that critically influences early brain injury (EBI) and long-term outcomes. However, the precise spatiotemporal dynamics and heterogeneity of immune cell infiltration and microglial reprogramming remain poorly understood. We aimed to construct a high-resolution immune atlas to delineate cell states, lineage trajectories, and spatial niches following SAH. MethodsWe integrated single-cell RNA sequencing (scRNA-seq) of CD45+ immune cells with spatial transcriptomics (ST) in a murine endovascular perforation SAH model. Immune landscapes were profiled at 24 hours (acute phase) and 72 hours (subacute phase) post-injury, compared with sham controls. Advanced bioinformatics integrated transcriptional signatures with spatial localization to map macrophage, neutrophil, and microglial dynamics. ResultsOur atlas reveals a coordinated immune transition from acute inflammation to reparative processing. We identified five macrophage, four neutrophil, and eight microglial subsets with distinct spatiotemporal patterns. Notably, we discovered a SAH-specific inflammatory microglial population (MG_03; Spp1+/Lpl+) that clusters at the rupture site during the acute phase. This subset is transcriptionally distinct from disease-associated microglia (DAM) in other neurodegenerative conditions. Trajectory analysis suggests MG_03 acts as a signaling hub for immune recruitment before transitioning toward proliferative and reparative states (MG_06-08) that disperse into the parenchyma by 72 hours. ConclusionsThis study provides the first comprehensive spatiotemporal immune atlas of SAH, highlighting the distinct role of the Spp1+ MG_03 subpopulation in early injury sensing. These findings offer a roadmap for identifying precise therapeutic windows and targeting specific immune subsets to mitigate EBI. Graphical AbstractExperimental workflow for single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) in a mouse SAH model induced by endovascular perforation. Brain tissue from the ipsilateral (injured) hemisphere was collected from sham and at 24 h and 72 h post-SAH. For scRNA-seq, CD45 immune cells were isolated prior to library preparation. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=124 SRC="FIGDIR/small/703421v1_ufig1.gif" ALT="Figure 1"> View larger version (39K): org.highwire.dtl.DTLVardef@4a1bc9org.highwire.dtl.DTLVardef@16664c4org.highwire.dtl.DTLVardef@1619725org.highwire.dtl.DTLVardef@a0d34_HPS_FORMAT_FIGEXP M_FIG C_FIG

Over the past four decades, ATP, the obligatory energy molecule for keeping all cells alive and functioning, was thought to contribute only one set of 31P MR signals in the human brain. Here we report for the first time the simultaneous detection of two pools of ATP in the human brain by high-resolution 3D 31P MRSI at ultrahigh field 7T. These two ATP pools differ in cytosolic Mg2+ concentration (1:0.5 ratio), with a resonance separation of 0.5 ppm at {beta}-ATP, a well-established imaging marker of intracellular Mg2+ concentration. Mg2+ is a cofactor of ATPase and its deficiency is associated with immune dysfunction, free radical damage, perturbations in Ca2+ homeostasis, and development of atherosclerosis, dyslipidemia and a number of neurological disorders, such as cerebral vasospasm, stroke, migraine, Alzheimers disease, and Parkinsons disease. Our study documents reduced Mg levels in the brain of patients with myelin oligodendrocyte glycoprotein antibody disorders (MOGAD), which is an idiopathic, inflammatory, demyelinating condition of the central nervous system (CNS) more common in pediatric patients. Low-Mg2+ ATP signals were detected mostly in the white matter regions in MOGAD, suggesting an association between Mg2+ deficiency and compromised functions of oligodendrocytes in maintenance and generation of the axonal myelin sheath. This preliminary study demonstrates the utility of the 7T 3D 31P MSRI for probing altered energy metabolism at reduced availability of Mg2+ rather than ATP itself. The potential correlation between [Mg2+] and disease progression over time should be assessed in larger cohorts. Author ApprovalYes

The hemodynamic response links neural oxidative metabolism changes to increased cerebral blood flow during brain activity1. Although Roy and Sherrington introduced this concept over a century ago (1890), the exact cellular mechanisms remain unclear. This study demonstrates how local blood supply increases correlate with the metabolic response of individual brain cells during locomotion. Using Raman microspectroscopy, we observed an elevation in oxygen saturation levels (sO2) in cortical venules but not in arterioles, which were already near saturation. The increased sO2 in the venules was accompanied by vasodilation, indicating blood oversupply in the local brain area, a phenomenon known as functional hyperemia. We then analyzed the metabolic response of individual neurons and astrocytes to locomotion. In neurons, the levels of reduced cytochromes of c and b types [cyt c,b (Fe2+)] rapidly decreased at the onset of locomotion. This suggests an increase in the activity of the mitochondrial respiratory chain (electron transport chain, ETC) in response to heightened energy demands in these cells2. In contrast, because astrocytes rely less on oxidative phosphorylation for their energy metabolism than neurons3, we did not observe an initial decrease in reduced cytochromes in these cells. However, as locomotion continued, the cyt c,b (Fe2+) levels steadily increased in both cell types. In neurons, this led to a slow recovery from the initial drop, while in astrocytes, the increase exceeded baseline levels. Consequently, we observed an overload of electrons in the astrocytic ETC. The distinct responses of astrocytic and neuronal mitochondria to locomotion may reflect differences in the organization of the ETC in the two cell types4. Furthermore, astrocytes may shift to glycolysis under increased neuronal activity5,6. This difference also resulted in hydrogen peroxide (H202) production in astrocytic mitochondria but not neuronal mitochondria. Since H202 is a signaling molecule critical for cognitive function in the brain7, we speculate that astrocytic mitochondria act as signaling hubs during exercise.

IntroductionEndothelial dysfunction represents the earliest detectable stage of atherosclerosis, is associated with an increased risk of cardiovascular events, and predicts cardiovascular disease (CVD) more effectively than traditional cardiovascular risk factors. Cerebrovascular reactivity (CVR) provides an index of endothelial function in the brain. Poor CVR is associated with stroke, cerebral small vessel disease, dementia, and even coronary artery disease. Traditional CVD risk factors are associated with low CVR in patients with known CVD and in older cohorts. However, the relationship between cardiovascular risk profile and reduced CVR in young adults who do not yet have CVD is uncertain. We hypothesized that in young adults undergoing routine clinical fMRI examinations for non-vascular disease low CVR measures would be associated with increased cardiovascular risk factors. MethodsThis cross-sectional study included adults who underwent a clinically indicated 3-Tesla fMRI scan of the brain for mapping of eloquent cortex including a "breath-hold task" as an imaging quality control measure. Individuals with intracranial masses and those with baseline CVD were excluded. The task consisted of 5[1/2], 20-second blocks of normal breathing interspersed with 20-second blocks of continuous breath holding. In breath hold fMRI scans, a voxel-wise comparison of brain T2 signal to an expected hemodynamic response curve is used to generate maps of voxel-wise t-statistics, indicating the probability that blood flow within a specific voxel had increased in response to changes in blood carbon dioxide levels. Using an axial slice 8 mm superior to the corpus callosum, a mean cerebral t-statistic was calculated for the slice as a comparative global measure of CVR in each patient. We retrospectively reviewed the charts of all individuals to characterize their clinical profile at the time of the fMRI. Based on the distribution of mean t-statistic values the sample was divided into two groups: high t-statistic ("normal reactivity") and low t-statistic value ("abnormal reactivity"). The distribution of cardiovascular risk factors was then compared across groups. ResultsBetween January 2014 and December 2023, 76 individuals underwent brain fMRI employing a "breath hold task" with suitable image quality for the current analysis (mean {+/-} SD age, 35.46 {+/-} 12.09 yrs.; 31.6% female). Mean {+/-} SD global CVR T-statistic was 3.97 {+/-} 1.62. Low CVR was defined as a mean T-statistic [&le;]4.2 (n=44, 57.9%). Individuals with abnormal CVR were older (age: 45.1 {+/-} 10.3 vs. 27.0 {+/-} 3.4 yrs., p<0.001), had a higher frequency of hypertension (31.8% vs. 14.3%, p=0.0069) and hyperlipidemia (18.2% vs. 3.1%, p=0.0449), and had higher systolic (123.5 {+/-} 13.2 vs. 116.9 {+/-} 12.2 mmHg, p=0.0282) and diastolic blood pressures (77.9 {+/-} 11.8 vs. 72.2 {+/-} 8.9, p=0.0141). Age, systolic blood pressure and hyperlipidemia were significantly associated with abnormal CVR in univariable and multivariable analyses (age, increase by 10 years OR: 2.00, 95% CI 1.40 - 2.78, p=0.0078; hyperlipidemia OR: 8.54, 95% CI 1.07 - 184.9, p=0.0049, and systolic blood pressure (OR for an increase in 10 mmHg: 1.57, 95% CI 1.10 - 2.10, p=0.0084). ConclusionTraditional cardiovascular risk factors are significantly associated with abnormal CVR in young adults without baseline CVD or cerebrovascular disease undergoing fMRI for reasons related to a diagnosis of epilepsy. Thus, CVR using fMRI could provide an integrated index of the collective burden of cardiovascular risk factors that could form a therapeutic target to prevent cardiovascular events.