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(Stroke. 2009;40:e515.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Krischek and Kasuya

Changbin Shi, MD, PhD Issam A. Awad, MD

Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, and Division of Neurosurgery, Northshore University HealthSystem, Chicago, Ill

H. Hunt Batjer, MD Bernard R. Bendok, MD

Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

We appreciate Dr Krischek and Kasuya’s thoughtful comments regarding our recent article "Genomics of Human Intracranial Aneurysm Wall" published in Stroke.¹ Our 2 study centers independently showed the potential critical role of the inflammatory and immune response pathways in aneurysm pathobiology.^1,2 We congratulate the authors on their work and innovative approach.

We agree that using the superficial temporal artery has limitations, but it is likely the best current option. Other options have limitations as well. Postmortem tissue has the disadvantage of excessive RNA degradation. Obtaining intracranial vessels during epilepsy or arteriovenous malformation surgery raises questions regarding genetic heterogeneity among different patients and populations. We do, however, acknowledge the value in examining these tissues.

In the study by Dr Krischek et al,² "pathological" intracranial arteriovenous malformation feeder vessels were used as control. Both the top-scoring networks in their study and our functional annotation pathway analysis demonstrated similar results implicating inflammatory and immune responses. This is interesting and encouraging particularly because different control vessels were used in the 2 studies. This lends further credibility to the hypothesis that inflammation plays a central role in intracranial aneurysm pathobiology. However, whether an antigen-driven immune response is at play needs further analysis. This has been shown to be the case in Kawasaki disease where an oligoclonal IgA immune response exists in the vascular wall.³ Our group recently discovered that an antigen-directed oligoclonal IgG immune response is present within cerebral cavernous malformation lesions.⁴

In addition to the inflammatory and immune response pathway, our study . . . [Full Text of this Article]

Related Article:

Gene Expression Microarray Studies of Intracranial Aneurysm Walls Lead to Similar Results

Boris Krischek and Hidetoshi Kasuya
Stroke 2009 40: e514. [Extract] [Full Text] [PDF]