start-ver=1.4
cd-journal=joma
no-vol=5
cd-vols=
no-issue=3
article-no=
start-page=119
end-page=123
dt-received=
dt-revised=
dt-accepted=
dt-pub-year=2019
dt-pub=20190930
dt-online=
en-article=
kn-article=
en-subject=
kn-subject=
en-title=
kn-title=Cerebral circulation improves with indirect bypass surgery combined with gene therapy
en-subtitle=
kn-subtitle=
en-abstract=
kn-abstract=Angiogenesis involves new blood vessels sprouting from preexisting blood vessels. This process may serve to improve brain circulation. Moyamoya disease (MMD) is a cerebrovascular disorder causing intracranial stenosis which significantly reduces the blood supply to the brain. Mainly stroke is the first symptom of the disorder, so treatments that reduce the risk of stroke are used for patients with MMD. To prevent stroke for those with chronic cerebral hypoperfusion, more blood needs to flow to the brain, which was thought to be achieved by enhancing angiogenesis. Indirect bypass surgery, such as encephalo-myo-synangiosis (EMS), is used for revascularization. However, EMS alone sometimes cannot provide enough circulation to avoid ischemic strokes. The current study examined if EMS combined with high-mobility group box-1 (HMGB1) and vascular endothelial growth factor (VEGF) enhanced angiogenesis and increased cerebral circulation. The results indicated that HMGB1 administered with EMS increased angiogenesis through a VEGF-dependent mechanism. In addition, exercising and stem cell transplantation possess possible means to increase angiogenesis. Overall, EMS with gene therapy, maintaining fitness, and stem cell utilization may prevent or help one recover from stroke by enhancing brain angiogenesis. Thus, these treatments may be applicable for patients with MMD. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed.
en-copyright=
kn-copyright=

en-aut-name=ShearAlex
en-aut-sei=Shear
en-aut-mei=Alex
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=1
ORCID=

en-aut-name=NishihiroShingo
en-aut-sei=Nishihiro
en-aut-mei=Shingo
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=2
ORCID=

en-aut-name=HishikawaTomohito
en-aut-sei=Hishikawa
en-aut-mei=Tomohito
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=3
ORCID=

en-aut-name=HiramatsuMasafumi
en-aut-sei=Hiramatsu
en-aut-mei=Masafumi
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=4
ORCID=

en-aut-name=SugiuKenji
en-aut-sei=Sugiu
en-aut-mei=Kenji
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=5
ORCID=

en-aut-name=YasuharaTakao
en-aut-sei=Yasuhara
en-aut-mei=Takao
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=6
ORCID=

en-aut-name=DateIsao
en-aut-sei=Date
en-aut-mei=Isao
kn-aut-name=
kn-aut-sei=
kn-aut-mei=
aut-affil-num=7
ORCID=

affil-num=1
en-affil=Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani
kn-affil=

affil-num=2
en-affil=Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=3
en-affil=Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=4
en-affil=Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=5
en-affil=Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=6
en-affil=Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=

affil-num=7
en-affil=Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University
kn-affil=
en-keyword=Angiogenesis
kn-keyword=Angiogenesis
en-keyword=cerebral hypoperfusion
kn-keyword=cerebral hypoperfusion
en-keyword=encephalo-myo-synangiosis
kn-keyword=encephalo-myo-synangiosis
en-keyword=endothelial progenitor cells
kn-keyword=endothelial progenitor cells
en-keyword=high-mobility group box-1
kn-keyword=high-mobility group box-1
en-keyword=revascularization
kn-keyword=revascularization
en-keyword=vascular endothelial growth factor
kn-keyword=vascular endothelial growth factor
END