This is a proposal to establish a Head Injury Research Center at the University of Vermont for the purposes of elucidating the role of the cerebrovascular endothelium in the development of secondary brain injury due to ischemia and intracranial hypertension. The investigators will test the hypothesis that derangements in cerebrovascular endothelium after brain injury, with or without shock and resuscitation, lead to perturbations in cerebral blood flow, thrombosis, and neutrophil activation/accumulation which promote vasogenic edema, brain swelling and increased intracranial pressure.
The specific aims encompass five interrelated areas of inquiry. PROJECT I will examine the role of the cerebrovascular endothelium in the control of pial anterior tone after brain injury alone, brain injury combined with hemorrhagic shock, and shock alone in a porcine model. PROJECT II will examine the effect of a percussion insult on endothelial regulation of thrombosis and fibrinolysis in an ex vivo model using segments of human pial arteries. PROJECT III will construct a mathematical model of intracranial pressure dynamics based upon changes in the vascular, cerebrospinal fluid, and brain tissue compartments in the normal and injured brain using a rabbit model for validation. PROJECT IV will examine the effect of neutrophil/endothelial interactions in the production of vasogenic edema in a rabbit model brain injury. PROJECT V will examine the effect of the osmolarity of intravenous fluids used for resuscitation on intracranial pressure in patients with moderate and severe brain injuries. The results of these studies should provide insights into the pathogenesis of ischemic secondary brain injury and provide direction for future therapy.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Exploratory Grants (P20)
Project #
5P20NS030324-03
Application #
2268366
Study Section
Special Emphasis Panel (SRC (66))
Project Start
1991-09-30
Project End
1996-09-29
Budget Start
1993-09-30
Budget End
1996-09-29
Support Year
3
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of Vermont & St Agric College
Department
Surgery
Type
Schools of Medicine
DUNS #
066811191
City
Burlington
State
VT
Country
United States
Zip Code
05405
Shackford, S R; Bourguignon, P R; Wald, S L et al. (1998) Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. J Trauma 44:50-8
Shackford, S R (1997) Effect of small-volume resuscitation on intracranial pressure and related cerebral variables. J Trauma 42:S48-53
Chappell, J E; Shackford, S R; McBride, W J (1997) Effect of hemodilution with diaspirin cross-linked hemoglobin on intracranial pressure, cerebral perfusion pressure, and fluid requirements after head injury and shock. J Neurosurg 86:131-8
Gourin, C G; Shackford, S R (1997) Production of tumor necrosis factor-alpha and interleukin-1beta by human cerebral microvascular endothelium after percussive trauma. J Trauma 42:1101-7
Shatos, M A; Doherty, J M; Penar, P L et al. (1996) Suppression of plasminogen activator inhibitor-1 release from human cerebral endothelium by plasminogen activators. A factor potentially predisposing to intracranial bleeding. Circulation 94:636-42
Chappell, J E; McBride, W J; Shackford, S R (1996) Diaspirin cross-linked hemoglobin resuscitation improves cerebral perfusion after head injury and shock. J Trauma 41:781-8
Luh, E H; Shackford, S R; Shatos, M A et al. (1996) The effects of hyperosmolarity on the viability and function of endothelial cells. J Surg Res 60:122-8
Gourin, C G; Shackford, S R (1996) Influence of percussion trauma on expression of intercellular adhesion molecule-1 (ICAM-1) by human cerebral microvascular endothelium. J Trauma 41:129-35
Schmoker, J D; Shackford, S R; Zhuang, J (1996) The effect of lesion volume on cerebral vasomotor tone after focal brain injury and shock. J Neurotrauma 13:67-78
Zhuang, J; Shackford, S R; Schmoker, J D et al. (1995) Colloid infusion after brain injury: effect on intracranial pressure, cerebral blood flow, and oxygen delivery. Crit Care Med 23:140-8

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