大鼠脑缺血再灌注后海马CA1区AS与Syp相关性分析

目的研究大鼠脑组织缺血再灌注后星形胶质细胞与Syp变化的关系。方法建立局灶性脑缺血再灌注模型,72只大鼠随机分为假手术组、缺血再灌注组,各时间点处死取脑,应用免疫组化法检测海马CA1区GFAP、Syp的表达。结果不同时间点缺血再灌注组GFAP、Syp表达均高于同时期假手术组(P<0.01);缺血再灌注组GFAP与Syp高度相关(P<0.01)。结论脑缺血再灌注后,海马CA1区星形胶质细胞与Syp变化具有高度相关性。     

大鼠脑缺血再灌注后海马CA1区星形胶质细胞与突触可塑性的关系

目的 研究大鼠脑组织缺血再灌注后星形胶质细胞与GAP-43变化的关系.方法 建立局灶性脑缺血再灌注模型.72只大鼠随机分为假手术组、缺血再灌注组,在各时间点处死取脑,应用免疫组化法检测海马CA1区GFAP、GAP-43的表达.结果 不同时间点缺血再灌注组GFAP、GAP-43表达均高于同时期假手术组(P＜0.01);缺血再灌注组GFAP与GAP-43高度相关(P＜0.05).结论 脑缺血再灌注后,海马CA1区星形胶质细胞与GAP-43变化具有高度相关性.     

EGb761对慢性脑缺血大鼠脑组织神经胶质细胞的影响

目的 探讨EGb761(银杏叶提取物)对慢性脑缺血大鼠脑组织神经胶质细胞的影响.方法 将雄性SD大鼠随机分为假手术组、单纯缺血组、EGb761干预组.制备慢性脑缺血大鼠模型,药物干预12周后,免疫组化方法分别检测各组大鼠脑组织中星形胶质细胞和少突胶质细胞的表达.结果 EGb761干预组大鼠的海马、胼胝体、皮质CNPase阳性细胞表达明显高于单纯缺血组,而海马、胼胝体、皮质GFAP阳性细胞表达明显低于单纯缺血组(P<0.05),差异有统计学意义.结论 慢性脑缺血时,EGb761对少突胶质细胞缺血性反应有保护作用,同时减少反应性星形胶质细胞增生.     

缺血后海马高迁移率族蛋白与星形胶质纤维酸蛋白表达及相关性

目的研究大鼠局灶性脑缺血再灌注星形胶质纤维酸蛋白(GFAP)与高迁移率族蛋白(HMGB1)在海马CA1区表达变化,探讨二者之间的关系。方法采用大脑中动脉栓塞2h制备SD大鼠脑缺血模型,60只雄性SD大鼠随机分为假手术组、缺血再灌注组,按1d、3d、7d、14d、28d时间点再分5个亚组,各时间点处死取脑,用免疫组化和荧光双标结合共聚焦扫描的方法来检测高迁移率族蛋白和星形胶质纤维酸蛋白在脑内海马CA1区表达变化。结果不同时间点缺血再灌注组GFAP、HMGB1表达均高于同时期的假手术组(P<0.05)。缺血再灌注组星形胶质细胞1d、3d、7d逐渐激活增生,7d达到高峰,14d开始下降;HMGB1在1d、3d、7d、14d是表达增加,14d达高峰,28d下降(与前一时间点比较P<0.05)。缺血再灌注组GFAP和HMGB1表达具有相关性(P<0.05),存在HMGB1和GFAP共定位细胞。结论脑缺血再灌注后,海马CA1区HMGB1增加与星形胶质细胞激活成正相关,过度表达的HMGB1和增殖的星形胶质细胞可能与缺血再灌注后神经元的迟发性损伤有关。     

远隔缺血后适应通过调节反应性星形胶质细胞的可塑性改善小鼠缺血后脑组织的恢复

目的星形胶质细胞的可塑性改变可以在脑缺血急性期引起脑水肿,在缺血恢复期改变胶质瘢痕的形成。本实验研究远隔缺血后适应(RIPC)在脑缺血再灌注损伤中对星形胶质细胞可塑性调节。方法脑缺血被诱导通过C57小鼠大脑中动脉短暂性的阻断1 h,在再灌注即刻给予RIPC。结果 RIPC能降低小鼠脑缺血再灌注3 d、14 d大脑半球的水肿、梗死面积,减少脑萎缩,提高神经功能恢复和生存率。而且RIPC能调节星形胶质细胞亚型的比例,在小鼠脑缺血再灌注3 d和14 d,RIPC能降低缺血侧纤维型星形胶质细胞(GFAP)及增加原浆型星形胶质细胞(GS)的表达,并且能够下调GFAPα的水平和上调GFAPδ/GFAPα的比例来调节GFAP的亚型。结论RIPC治疗能调节反应性星形胶质细胞的可塑性,提高缺血后神经功能的恢复。     

大鼠前脑缺血再灌注后GFAP、S-100表达的变化

目的 探讨胶质纤维酸性蛋白（GFAP）和S-100蛋白在大鼠前脑缺血再灌注后反应性星形胶质细胞的活化情况.方法 利用免疫组织化学方法检测前脑缺血再灌注模型的细胞活化情况.结果 脑缺血再灌注后第1d,顶叶皮层和海马可见少量GFAP阳性细胞表达 脑缺血再灌注第3d及第5d后GFAP阳性表达明显增加,并与对照组比较有统计学意义（P＜0.01）.S-100蛋白在脑缺血再灌注后第1d即有增加,并随着时间延长表达明显增强,各时间点与对照组有显著性差异（P＜0.01）.结论 脑缺血再灌注后GFAP、S-100蛋白表达增加,说明反应性星形胶质细胞的活化参与了脑缺血损伤后神经元的修复过程.     

腺苷预处理对脑缺血再灌注脑内星形胶质细胞的影响

目的 探讨腺苷预处理对脑缺血再灌注损伤脑内星形胶质细胞的影响.方法 制作大鼠脑缺血再灌注损伤模型.60只SD大鼠随机分为3组:假手术组(F组)、缺血再灌注组(IR组)、腺苷预处理组(AP组),再按缺血再灌注后不同时间把各组随机分成4个亚组,每组5只大鼠.应用Zeal Longa 5级评分法进行神经功能评分,并通过免疫组织化学法检测脑组织内胶质纤维酸性蛋白(glial fibrillary acid protein,GFAP)的表达.结果 (1)神经功能评分AP组各亚组均小于IR组各亚组(P均＜0.05),但大于F组各亚组(P均＜0.05);(2)F组GFAP阳性表达均较弱,IR组和AP组在脑缺血再灌注后2h开始出现GFAP阳性表达的细胞数量增多,AP组在6h、24h AP组GFAP阳性表达比IR组增强(P均＜0.05),在72h时AP组GFAP阳性表达较IR组减少(P＜0.05).结论 腺苷预处理能在大鼠局灶性脑缺血再灌注损伤早期阶段促进GFAP的表达,72h后抑制GFAP的过度表达.     

局部亚低温对局灶脑缺血再灌注后梗死体积、胶质纤维酸性蛋白表达的影响

目的　观察病变侧缺血至再灌期亚低温 (32～ 33℃ )对局灶脑缺血再灌注后梗死体积、星形胶质细胞胶质纤维酸性蛋白 (GFAP)表达的影响。方法　采用改良线栓法建立大鼠大脑中动脉缺血再灌注模型 ,缺血 30min后应用反馈控温半导体制冷块对大鼠病变侧给予亚低温治疗 ,并持续至再灌期。采用免疫组织化学方法检测GFAP表达 ,TTC染色测梗死体积。结果　同常温组相比梗死体积明显减少 (P <0 .0 5 ) ,缺血常温组GFAP阳性细胞数量增多 ,突体粗大 ,胞体肿胀 ;亚低温组GFAP表达数量明显减少。结论　病变侧亚低温能明显抑制脑缺血后星形胶质细胞反应性增生和肥大。缺血至再灌期亚低温明显减轻脑组织损伤。     

小鼠大脑中动脉缺血再灌注后缺血区及周边区星形胶质细胞的变化

目的 探讨小鼠大脑中动脉缺血再灌注后脑梗死体积、星形胶质细胞(AS)病理形态及其蛋白表达的变化.方法 选取69只成年健康雄性KM小鼠,将小鼠随机分为脑缺血2h再灌注1、4、10、24、48、72 h模型组(n=9)以及假手术组(n=6,仅结扎右侧颈总动脉)和正常组(n=9).采用线栓法制备小鼠大脑中动脉局灶性脑缺血再灌注模型.应用2,3,5-氯化三苯基四氮唑(TTC)染色法观察脑梗死的部位与体积;免疫组化法观察脑缺血中心区与周边区不同再灌注时间点胶质纤维酸性蛋白(GFAP)的表达.结果 缺血再灌注1h开始出现脑梗死灶,且再灌注24 h时梗死体积最大,之后逐渐缩小(F=745.534,P=0.000).小鼠脑缺血再灌注后缺血中心区AS肿胀、肥大进而较快发生凋亡,其GFAP表达水平低于周边区(P＜0.05);而缺血周边区GFAP阳性表达的AS出现反应性活化,进而发生形态学改变;缺血周边区及对侧相应脑组织区域GFAP的表达量均随再灌注时间的延长呈现增加趋势(P＜0.05).结论 AS反应性活化可能是一种缺血后的全脑保护性防御机制,尤其是在缺血周边区,其活化程度影响脑组织的存活与修复,提示在脑缺血再灌注过程中AS反应性活化可能在脑损伤后可塑性形态及功能改变中发挥重要作用.     

一氧化氮供体及前体对大鼠脑缺血再灌注损伤保护机制的探讨

目的 观察介入给药一氧化氮（NO）供体硝酸甘油（Nitroglycerine，NG）及前体L-精氨酸（L-Arginine，ARG）对大鼠脑缺血再灌注后海马区星形胶质细胞表达的胶质纤维酸性蛋白（GFAP）的影响，探讨NG及ARG的脑保护机制。方法 采用大鼠大脑中动脉阻塞（MCAO）法建立局灶性脑缺血模型。将大鼠随机分为假手术组、MCAO组、NG组和ARG组。MCAO组、NG组和ARG组于缺血2 h再灌注同时分别局部介入给予生理盐水、NG和ARG，于再灌注3 h或24 h时，荧光法检测血清NO含量。并在3 h或24 h时处死大鼠，病理分析脑梗死体积以及免疫组织化学法检测海马区GFAP表达情况。结果 缺血再灌注后3 h血清NO升高（P <0.01），治疗组较MCAO组明显（P <0.01），GFAP表达阳性细胞数增加，但治疗组较MCAO组减少（P <0.01），各组大鼠脑组织未出现肉眼可见梗死灶；缺血再灌注后24 h，血清NO治疗组较3 h降低，而MCAO组较3 h升高（P <0.05），GFAP表达阳性细胞数较3 h增加（P <0.01），治疗组较MCAO组减少（P <0.01），TTC染色显示脑梗死体积治疗组较MCAO组减小（P <0.05）。结论 脑缺血再灌注后海马区脑组织GFAP表达增强，通过局部介入给予NG、ARG增加NO合成，抑制GFAP高表达，减小脑梗死体积。提示NG、ARG抗脑缺血性损伤的保护机制可能与抑制星形胶质细胞过度表达有关。     

Characteristics of diffusion-tensor imaging for healthy adult rhesus monkey brains

Diffusion-tensor imaging can be used to observe the microstructure of brain tissue. Fractional ani- sotropy reflects the integrity of white matter fibers. Fractional anisotropy of a young adult brain is low in gray matter, high in white matter, and highest in the splenium of the corpus callosum. Thus, we selected the anterior and posterior limbs of the internal capsule, head of the caudate nucleus, semioval center, thalamus, and corpus callosum （splenium and genu） as regions of interest when using diffusion-tensor imaging to observe fractional anisotropy of major white matter fiber tracts and the deep gray matter of healthy rhesus monkeys aged 4-8 years. Results showed no laterality dif- ferences in fractional anisotropy values. Fractional anisotropy values were low in the head of cau- date nucleus and thalamus in gray matter. Fractional anisotropy values were highest in the sple- nium of corpus callosum in the white matter, followed by genu of the corpus callosum and the pos- terior limb of the internal capsule. Fractional anisotropy values were lowest in the semioval center and posterior limb of internal capsule. These results suggest that fractional anisotropy values in major white matter fibers and the deep gray matter of 4-8-year-old rhesus monkeys are similar to those of healthy young people.     

Glial activation and white matter changes in the rat brain induced by chronic cerebral hypoperfusion: an immunohistochemical study

Activation of glial cells and white matter changes (rarefaction of the white matter) induced in the rat brain by permanent bilateral occlusion of the commom carotid arteries were immunohistochemically investigated up to 90 days. One day after ligation of the arteries, expression of the major histocompatibility complex (MHC) class I antigen in microglia increased in the white matter including the optic nerve, optic tract, corpus callosum, internal capsule, anterior commissure and traversing fiber bundles of the caudoputamen. After 3 days of occlusion, MHC class I antigen was still elevated and in addition MHC class II antigen and leukocyte common antigen were up-regulated in the microglia in these same regions. Astroglia, labeled with glial fibrillary acidic protein, increased in number in these regions after 7 days of occlusion. A few lymphocytes, labeled with CD4 or CD8 antibodies, were scattered in the neural parenchyma 1 h after occlusion. Activation of glial cells and infiltration of lymphocytes persisted after 90 days of occlusion in the white matter and the retinofugal pathway. However, cellular activation and infiltration in microinfarcts of the gray matter was less extensive and was substantially diminished 30 days after occlusion. The white matter changes were most intense in the optic nerve and optic tract, moderate in the medial part of the corpus callosum, internal capsule and anterior commissure, and slight in the fiber bundles of the caudoputamen. These results indicated that chronic cerebral hypoperfusion induced glial activation preferentially in the white matter. This activation seemed to be an early indicator of the subsequent changes in the white matter.     

Axonal damage and demyelination in the white matter after chronic cerebral hypoperfusion in the rat

Cerebral white matter (WM) lesions are observed frequently in human ischemic cerebrovascular disease and have been thought to contribute to cognitive impairment. This type of lesion can be experimentally induced in rat brains under chronic cerebral hypoperfusion by the permanent occlusion of both common carotid arteries. However, it remains uncertain whether chronic ischemia can damage both the gray and white matter, and whether it can induce demyelination with or without axonal damage. Therefore, we examined axonal damage using immunohistochemistry for the amyloid beta/A4 precursor protein (APP), chromogranin A (CgA) and demyelination using immunohistochemistry for the encephalitogenic peptide (EP) in this model. Severe WM lesions such as vacuolation and the loss of nerve fibers appeared in the optic nerve and optic tract after 3 days of ligation, and less intense changes were observed in the corpus callosum, internal capsule, and fiber bundles of the caudoputamen after 7 days with Klüver-Barrera and Bielschowsky staining. These WM lesions persisted even after 30 days. The APP, CgA, and EP-immunopositive fibers increased in number from 1 to 30 days after the ligation in the following WM regions: the optic nerve, optic tract, corpus callosum, internal capsule, and fiber bundles of the caudoputamen. In contrast, only a few APP, CgA, or EP-immunopositive fibers were detected in the gray matter regions, including the cerebral cortex and hippocampus. These results indicate that the WM is more susceptible to chronic cerebral hypoperfusion than the gray matter, with an involvement of both axonal and myelin components. Furthermore, immunohistochemistry for APP, CgA, and EP is far superior to routine histological staining in sensitivity and may become a useful tool to investigate WM lesions caused by various pathoetiologies.     

Experimental cerebral hypoperfusion induces white matter injury and microglial activation in the rat brain

Though cerebral white matter injury is a frequently described phenomenon in aging and dementia, the cause of white matter lesions has not been conclusively determined. Since the lesions are often associated with cerebrovascular risk factors, ischemia emerges as a potential condition for the development of white matter injury. In the present study, we induced experimental cerebral hypoperfusion by permanent, bilateral occlusion of the common carotid arteries of rats (n=6). A sham-operated group served as control (n=6). Thirteen weeks after the onset of occlusion, markers for astrocytes, microglia, and myelin were found to be labeled by means of immunocytochemistry in the corpus callosum, the internal capsule, and the optic tract. The ultrastructural integrity and oligodendrocyte density in the optic tract were investigated by electron microscopy. Quantitative analysis revealed that chronic cerebral hypoperfusion caused mild astrogliosis in the corpus callosum and the internal capsule, while astrocytic disintegration in the optic tract increased by 50%. Further, a ten-fold increase in microglial activation and a nearly doubled oligodendrocyte density were measured in the optic tract of the hypoperfused rats as compared with the controls. Finally, vacuolization and irregular myelin sheaths were observed at the ultrastructural level in the optic tract. In summary, the rat optic tract appears to be particularly vulnerable to ischemia, probably because of the rat brains angioarchitecture. Since the detected glial changes correspond with those reported in vascular and Alzheimer dementia, this model of cerebral hypoperfusion may serve to characterize the causal relationship between ischemia and white matter damage.     

Biochemical and immunocytochemical changes in glial fibrillary acidic protein after stab wounds

Changes of glial fibrillary acidic protein (GFAP) in the forebrain of rats with stab wounds were determined by quantitative immunoblots and by immunohistochemistry. Bilateral stab wounds were made stereotaxically in the cortex and hippocampus. In control rats, the scalp was retracted and depressions were etched on the intact skull. At various times up to 21 days postoperation, one cerebral hemisphere was homogenized, proteins were separated by polyacrylamide gel electrophoresis and immunoblots were quantitated by densitometry. The contralateral hemisphere was immunostained for GFAP. Three hours postoperation GFAP+ cells were detected around the wound but there was no increase of total GFAP. At 6 h postoperation total GFAP in the forebrain decreased to 80% of the sham-operated control value and the number of GFAP+ cells was lower, compared to the controls, in layer 1 of the cortex, corpus callosum, cingulum, external capsule, internal capsule, hippocampus, optic tracts and around blood vessels. This early relative decrease in GFAP levels was actually due to an increase in GFAP in the sham-operated controls, which mounted a stronger gliotic response during the first 24 h. In neither group of animals did the GFAP levels drops below those of intact unoperated animals. At 24 h total GFAP began to increase. The number and intensity of reactive glia in the vicinity of the wound increased steadily, appearing to reach a maximum at about 7 days, then declining significantly by 21 days. The glial reaction was most pronounced in the hippocampus. Total GFAP reached 180% of the control value by 7 days and then declined to 117% by 21 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diffusion tensor imaging of periventricular leukomalacia shows affected sensory cortex white matter pathways

The authors used diffusion-tensor imaging to examine central white matter pathways in two children with spastic quadriplegic cerebral palsy. Corticospinal tracts projecting from cortex to brainstem resembled controls. In contrast, posterior regions of the corpus callosum, internal capsule, and corona radiata were markedly reduced, primarily in white matter fibers connected to sensory cortex. These findings suggest that the motor impairment in periventricular leukomalacia may, in part, reflect disruption of sensory connections outside classic pyramidal motor pathways.     

Detection of wallerian degeneration in a newborn by diffusion magnetic resonance imaging (MRI)

We present the case of an infant with hypoxic-ischemic encephalopathy in whom wallerian degeneration is demonstrated in white-matter fiber tracts by diffusion magnetic resonance imaging (MRI). MRI was undertaken on days 2 and 9 and then at 9 months of age. On day 2, conventional MRI was normal, but diffusion MRI showed bioccipital abnormalities. On day 9, diffusion MRI showed marked abnormalities in the deep white matter of the occipital regions (left > right), corpus callosum, left posterior limb of the internal capsule, and left cerebral peduncle. Water apparent diffusion coefficient values showed a significant reduction in the left occipital white matter and corpus callosum between days 2 and 9 while demonstrating the expected pseudonormalization in cortical gray matter. Images at 9 months showed left occipital porencephaly and atrophy of the left cerebral peduncle, with the infant displaying right hemiplegia at 18 months of age. In this case, the time course of diffusion changes differed between white and gray matter, with diffusion MRI showing delayed wallerian degeneration of the cerebral white matter. This case characterizes this degeneration with clinical and follow-up MRI at 9 months of age.     

Neurovirulent simian immunodeficiency virus induces calbindin-D-28K in astrocytes

Astrocyte activation has been postulated to be a major contributor to functional changes in the brain of AIDS patients. We assessed astrocyte activation in the simian immunodeficiency virus (SIV) model. Four groups of macaque brains were examined: uninoculated controls, animals inoculated with virus that did not cause disease, animals inoculated with virus that caused AIDS but did not cause encephalitis, and animals with SIV encephalitis. We examined expression of calbindin-D-28K, a calcium binding protein that is upregulated in astrocytes during excitotoxic events, as well as glial fibrillary acidic protein (GFAP). The presence of calbindin in astrocytes was confirmed by double-labeling using confocal microscopy. Increases in calbindin staining were most apparent in the white matter, but increases in GFAP staining were most apparent in middle layers of the cerebral cortex. Six of the seven animals with SIV encephalitis had calbindin immunoreactive astrocytes in the subcortical white matter, corpus callosum, internal capsule, cerebral peduncle, pontine white matter, and cerebellar white matter. Very rarely, a few, very lightly calbinding-immunoreactive astrocytes were present in the uninoculated control brains. The increase in calbindin expression by astrocytes in SIV encephalitis suggests that these cells are subject to calcium toxicity. In uninoculated control macaques, and in macaques inoculated with virus that did not cause disease, GFAP-immunoreactive astrocytes were present throughout the subcortical white matter and in layer I, but very few were found in layers III–V of the cerebral cortex. Two animals that died of AIDS without encephalitis had somewhat higher numbers of GFAP immunoreactive astrocytes in middle cortical layers. In seven animals that received passaged neurovirulent virus and developed both AIDS and encephalitis, the number of GFAP-immunoreactive astrocytes in middle cortical layers was high, indicating widespread astrocyte activation.     

White matter tract injury and cognitive impairment in human immunodeficiency virusinfected individuals

Approximately half of those infected with the human immunodeficiency virus (HIV) exhibit cognitive impairment, which has been related to cerebral white matter damage. Despite the effectiveness of antiretroviral treatment, cognitive impairment remains common even in individuals with undetectable viral loads. One explanation for this may be subtherapeutic concentrations of some antiretrovirals in the central nervous system (CNS). We utilized diffusion tensor imaging and a comprehensive neuropsychological evaluation to investigate the relationship of white matter integrity to cognitive impairment and antiretroviral treatment variables. Participants included 39 HIV-infected individuals (49% with acquired immunodeficiency syndrome [AIDS]; mean CD4=529) and 25 seronegative subjects. Diffusion tensor imaging indices were mapped onto a common whole-brain white matter tract skeleton, allowing between-subject voxelwise comparisons. The total HIV-infected group exhibited abnormal white matter in the internal capsule, inferior longitudinal fasciculus, and optic radiation; whereas those with AIDS exhibited more widespread damage, including in the internal capsule and the corpus callosum. Cognitive impairment in the HIV-infected group was related to white matter injury in the internal capsule, corpus callosum, and superior longitudinal fasciculus. White matter injury was not found to be associated with HIV viral load or estimated CNS penetration of antiretrovirals. Diffusion tensor imaging was useful in identifying changes in white matter tracts associated with more advanced HIV infection. Relationships between diffusion alterations in specific white matter tracts and cognitive impairment support the potential utility of diffusion tensor imaging in examining the anatomical underpinnings of HIV-related cognitive impairment. The study also confirms that CNS injury is evident in persons infected with HIV despite effective antiretroviral treatment.     

Quantitative structural changes in white and gray matter 1 year following traumatic brain injury in rats

There is evidence for chronic atrophy after human head trauma, which may be associated with long-term functional deficits. However, using established models of traumatic brain injury (TBI) only limited data are available for clarifying the extent of progressive gray and white matter atrophy. In the present study, male Sprague-Dawley rats underwent moderate (2.01-2.21 atm) parasagittal fluid percussion brain injury ( n=7) or sham ( n=3) surgery and were killed at 1 year post TBI. Semiserial sections were obtained through the neuraxis and double stained with hematoxylin and eosin to demarcate gray matter structures and Luxol fast blue for white matter visualization. Both ipsilateral and contralateral volume measurements were obtained for the following structures: cerebral cortex, hippocampus, dentate gyrus, thalamus, lateral ventricle, external capsule, internal capsule, cerebral peduncle and corpus callosum. Quantitative assessment of ipsilateral gray matter structures from TBI rats revealed significant reductions in cerebral cortical area measurements posterior from the trauma epicenter compared to sham animals. Importantly, several white matter tracts exhibited dramatic atrophy. A comparison of TBI and sham groups demonstrated a significant ( P<0.05) decrease in the external capsule and cerebral peduncle volumes ( P<0.007). In addition, there was a significant volume expansion (533% of control) of the ipsilateral lateral ventricle ( P<0.03). These novel data emphasize the need to clarify the pathophysiology of progressive white matter damage after TBI and the development of therapeutic strategies to target white matter pathology.