PubMed: 27125525

Title
Hematoma Changes During Clot Resolution After Experimental Intracerebral Hemorrhage.
Journal
Stroke
Volume
47
Issue
None
Pages
1626-31
Date
2016-06-01
Authors
Cao S | Chen G | Hua Y | Keep RF | Xi G | Zheng M

Evidence 5be010ab33

The diameter of RBCs within the hematoma decreased with time after ICH.

Evidence 3d8110807d

We found that hemoglobin contents in hematoma were significantly higher in the DFX treated group compare to the vehicle-treated group (15.9 ± 1.8 vs. 11.8 ± 0.8 mg/g, p<0.05, Fig. 5A).

Evidence 21ab602b7e

DFX also reduced the MAC content in the clot at day-3 (33.0 ± 6.6 vs. 56.2 ± 9.2 ng/g in the vehicle-treated group, p<0.05, Fig. 5B).

Evidence 5f740aaa72

The present study found that DFX treatment reduces MAC formation in the clot.

Evidence 91e6da39e9

These results suggested that the treatment of DFX reduced the process of hemolysis after ICH, which might be due to alleviating MAC formation.

Evidence 6f12225c03

The loss of CD47 in the clot was reduced significantly by DFX treatment at day 3 (CD47/GAPDH: 1.32 ± 0.16 in ICH+DFX group vs. 0.74 ± 0.07 in ICH + vehicle group, p<0.05, Fig. 5C) and day 7 (p<0.01, Suppl Figure I).

Evidence e446c7ec44

DFX also reduced CD47 loss and microglia/macrophage infiltration after ICH suggesting it also affects erythrophagocytosis.

Evidence 417a624382

DFX treatment also caused a significant reduction in infiltrating CD163-positive and HO-1 positive cell in the hematoma at day 3 (Figs. 6A and B) and day 7 (Suppl Figures II & III).

Evidence 1c2a2e5ba5

Western blot analysis showed that the protein expression of HO-1 was decreased in the hematoma in the DFX treated group at day 3( HO-1/GAPDH: 0.32 ± 0.04 vs. 0.98 ± 0.07 in the vehicle-treated group, p<0.05, Fig. 6B) and day 7 (p<0.05, Suppl Figure III).

Evidence 0972c21e2e

In combination, these finding may underlie our previous results showing that DFX slows hematoma resolution after ICH in aged rats 12.

Evidence eeefa0b10f

CD163 mediated hemoglobin/hematoma clearance is involved in the induction of HO-1, a rate-limiting enzyme for heme degradation 26.

Evidence c077f16923

Erythrophagocytosis was observed in the hematoma edge at day-3 (Fig. 3A), and hemosiderin deposition was identifiable in the hematoma edge at day-7 (Fig. 3A).

Evidence f05f4088f0

CD47 exerts its inhibitory effect on phagocytosis through binding to inhibitory immunoreceptor SIRPα expressed by microglia/macrophages 21.Thus, the CD47-SIRPα constitutes a negative feedback for erythrophagocytosis22.

Evidence a9dfbb1f13

Evidence suggested that CD163 acts as a hemoglobin scavenger receptor on microglia/macrophage with a role in erythrophagocytosis.

Evidence 6f6198b580

A recent study, however, indicated that HO-1 is associated with blood clearance by enhancing erythrophagocytosis after stroke.

Evidence eb32854d4f

Erythrocyte lysis after ICH can be mediated by the complement activation and formation of the membrane attack complex (MAC), which contains complement C5b, C6, C7, C8 and C9 proteins (C5b– 9).

Evidence c23de78734

Activation of the complement system and the formation of MAC resulted in an increased membrane permeability and erythrocyte lysis.

Evidence a837a09f0c

Following complement cascade activation, MAC on the cell membrane forms a pore resulting in membrane permeability changes17 finally leading to RBC morphological alterations and erythrocyte lysis.

Evidence 755e4ca19b

In this present study, MAC contents in the clot gradually increased with a marked accumulation at day-3 (53.5 ± 8.2 vs. 11.0 ± 3.9 ng/g at 4 hour, p<0.01, Fig. 2C) and stayed at high levels at day 7.

Evidence 02049f41b4

We found that diameter of RBC decreased gradually in the hematoma edge and hematoma center (e.g. day-3 at hematoma edge: 2.71 ± 0.38μm vs. 3.89 ± 0.35μm at 4 hours, p<0.01; hematoma center: 2.61 ± 0.29 μm vs. 3.75 ± 0.25μm at 4 hours, p<0.01. Fig. 1).

Evidence 0e4109d5cd

The hematoma clearance may be via red blood cell (RBC) lysis or phagocytosis.

Evidence a6d3ebc4f3

The level of hemoglobin declined gradually over the time after the onset of ICH with a significant reduction at day 3. The contents of hemoglobin in the clot were 26.2 ± 5.2 mg/g at 4 hours, but were reduced to 13.9 ± 0.9 mg/g at day-3 (Fig. 2B, p<0.01).

Evidence 2435ed9450

CD163 and HO-1 positive cells infiltrated into the hematoma from edge to center after ICH (Figs. 4A & 4B). A significant increase of CD163 cells was found at day 3.

Evidence c556ef8b8c

The current study examined the natural time course of CD47 expression in the hematoma in a swine ICH model and found that CD47 levels in the clot decrease with time.

Evidence 8e622036c3

Our recent study showed that depleting CD47 in RBCs resulted in faster hematoma clearance with microglia/ macrophages being less likely to phagocytize RBCs with CD47 than CD47-deficient RBC 7.

Evidence 5f7ae3004d

HO-1 protein levels in the hematoma also increased at day-3 (HO-1/GAPDH: 0.65 ± 0.08 at day-3 vs. 0.04 ± 0.01 at 4 hour, p<0.01).

Evidence e02d1e5392

Hematoma resolution occurs in the days after intracerebral hemorrhage (ICH).

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