Cerebral vasospasm (CV) remains a significant cause of delayed neurological deficit and ischemic damage after subarachnoid hemorrhage (SAH), despite intensive research effort. The current lack of an effective therapeutic approach is somewhat due to our lack of understanding regarding the mechanism by which this pathological constriction develops. Recent evidence implicates bilirubin oxidation products (BOXes) in the etiology of CV after SAH: BOXes are found in cerebrospinal fluid from SAH patients with symptomatic or angiographically visible vasospasm (CSF V ) but not in CSF from SAH patients with no vasospasm (CSF C ). We have previously published research suggesting that the etiology of CV comprises two components: a physiological stimulation to constrict and a pathological failure to relax. Both these components are elicited by CSF V , but not CSF C , and BOXes synthesized in the laboratory potentiate physiological constriction in arterial smooth muscle in vitro, and elicit contraction in pial arteries in vivo. In this paper, we will present our results concerning the action of BOXes on arterial smooth muscle constriction, compared with CSF V . We will also present evidence implicating temporal changes in PKC isoforms and Rho expression in both BOXes-and CSF V -elicited smooth muscle responses.
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INTRODUCTIONWorldwide, subarachnoid hemorrhage (SAH) and its sequel, cerebral vasospasm (CV), kill or seriously debilitate an estimated 1.2 million people, of both genders, and all ages and ethnic groups annually (1). In the United States alone, complications from SAH, including increased length of hospital stay, increased treatment intensity level, requirement for long-term care and intensive rehabilitation are estimated to have cost 500 million dollars in 2000 (2). The pathological constriction of cerebral vessels that occurs during CV may lead to ischemia, infarction or death (3,4) and the 3-10 days between the initial hemorrhage and onset of CV potentially affords the clinician a therapeutic window (5). Unfortunately, despite considerable research efforts, the etiology of CV is still unknown, and appears to be a complex combination of events (3,6-10) Our research indicates that the intractable vasoconstriction seen in CV after SAH is a combination of a physiological protein kinase C-mediated contraction, followed by a pathological failure to relax, mediated by Rho-mediated inhibition of myosin light chain Send correspondence to: Dr Gail Pyne-Geithman, Department of Neurology, University of Cincinnati, 2324 Vontz Center, 3125 Eden Avenue, Cincinnati, OH USA
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript phosphatase (9,11). Bilirubin oxidation products (BOXes) may be responsible for one or both of these events (12-14).The literature records a bewildering array of molecules that may be implicated in the etiology of CV after SAH. They include endothelin (15), hemoglobin (7,16), bilirubin and it's oxidation products (17-19), arachidonic acid and it's peroxidized metabolites...