[1] M.T. Lawton, G.E. Vates, Subarachnoid Hemorrhage, The New England journal of
medicine 2017;377:257-266.
[2] S.N. Neifert, E.K. Chapman, M.L. Martini, et al., Aneurysmal Subarachnoid Hemorrhage:
the Last Decade, Translational stroke research 2021;12:428-446.
[3] A. Morita, T. Kirino, K. Hashi, et al., The natural course of unruptured cerebral
aneurysms in a Japanese cohort, The New England journal of medicine 2012;366:2474-2482.
[4] D.O. Wiebers, D.G. Piepgras, R.D. Brown, Jr., et al., Unruptured aneurysms, Journal of
18
neurosurgery 2002;96:50-51; discussion 58-60.
[5] M.J. Wermer, I.C. van der Schaaf, A. Algra, et al., Risk of rupture of unruptured
intracranial aneurysms in relation to patient and aneurysm characteristics: an updated
meta-analysis, Stroke; a journal of cerebral circulation 2007;38:1404-1410.
[6] J.P. Greving, M.J. Wermer, R.D. Brown, Jr., et al., Development of the PHASES score for
prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective
cohort studies, The Lancet. Neurology 2014;13:59-66.
[7] T. Aoki, J. Frosen, M. Fukuda, et al., Prostaglandin E2-EP2-NF-kappaB signaling in
macrophages as a potential therapeutic target for intracranial aneurysms, Sci Signal
2017;10:eaah6037.
[8] T. Aoki, H. Kataoka, R. Ishibashi, et al., Impact of monocyte chemoattractant protein-1
deficiency on cerebral aneurysm formation, Stroke; a journal of cerebral circulation
2009;40:942-951.
[9] T. Aoki, H. Kataoka, M. Morimoto, et al., Macrophage-derived matrix metalloproteinase2 and -9 promote the progression of cerebral aneurysms in rats, Stroke; a journal of cerebral
circulation 2007;38:162-169.
[10] T. Aoki, H. Kataoka, M. Shimamura, et al., NF-kappaB is a key mediator of cerebral
aneurysm formation, Circulation 2007;116:2830-2840.
[11] T. Aoki, M. Nishimura, T. Matsuoka, et al., PGE(2) -EP(2) signalling in endothelium is
activated by haemodynamic stress and induces cerebral aneurysm through an amplifying
loop via NF-kappaB, British journal of pharmacology 2011;163:1237-1249.
[12] Y. Kanematsu, M. Kanematsu, C. Kurihara, et al., Critical roles of macrophages in the
formation of intracranial aneurysm, Stroke; a journal of cerebral circulation 2011;42:173-178.
[13] H. Koseki, H. Miyata, S. Shimo, et al., Two Diverse Hemodynamic Forces, a Mechanical
Stretch and a High Wall Shear Stress, Determine Intracranial Aneurysm Formation,
Translational stroke research 2020;11:80-92.
19
[14] M. Kushamae, H. Miyata, M. Shirai, et al., Involvement of neutrophils in machineries
underlying the rupture of intracranial aneurysms in rats, Sci Rep 2020;10:20004.
[15] R.M. Starke, N. Chalouhi, P.M. Jabbour, et al., Critical role of TNF-alpha in cerebral
aneurysm formation and progression to rupture, Journal of neuroinflammation 2014;11:77.
[16] K. Shimizu, M. Kushamae, T. Mizutani, et al., Intracranial Aneurysm as a Macrophagemediated Inflammatory Disease, Neurol Med Chir (Tokyo) 2019;59:126-132.
[17] J. Frosen, J. Cebral, A.M. Robertson, et al., Flow-induced, inflammation-mediated
arterial wall remodeling in the formation and progression of intracranial aneurysms,
Neurosurg Focus 2019;47:E21.
[18] R. Tulamo, J. Frosen, J. Hernesniemi, et al., Inflammatory changes in the aneurysm
wall: a review, J Neurointerv Surg 2018;10:i58-i67.
[19] S. Muhammad, S.R. Chaudhry, G. Dobreva, et al., Vascular Macrophages as Therapeutic
Targets to Treat Intracranial Aneurysms, Front Immunol 2021;12:630381.
[20] T. Aoki, H. Kataoka, R. Ishibashi, et al., Pitavastatin suppresses formation and
progression of cerebral aneurysms through inhibition of the nuclear factor kappaB pathway,
Neurosurgery 2009;64:357-365; discussion 365-366.
[21] T. Aoki, H. Kataoka, R. Ishibashi, et al., Simvastatin suppresses the progression of
experimentally induced cerebral aneurysms in rats, Stroke; a journal of cerebral circulation
2008;39:1276-1285.
[22] R. Yamamoto, T. Aoki, H. Koseki, et al., A sphingosine-1-phosphate receptor type 1
agonist, ASP4058, suppresses intracranial aneurysm through promoting endothelial
integrity and blocking macrophage transmigration, British journal of pharmacology
2017;174:2085-2101.
[23] G. Chinetti-Gbaguidi, S. Colin, B. Staels, Macrophage subsets in atherosclerosis, Nat
Rev Cardiol 2015;12:10-17.
[24] H. Jinnouchi, L. Guo, A. Sakamoto, et al., Diversity of macrophage phenotypes and
20
responses in atherosclerosis, Cell Mol Life Sci 2020;77:1919-1932.
[25] A. Mantovani, S.K. Biswas, M.R. Galdiero, et al., Macrophage plasticity and polarization
in tissue repair and remodelling, J Pathol 2013;229:176-185.
[26] D.M. Mosser, J.P. Edwards, Exploring the full spectrum of macrophage activation,
Nature reviews. Immunology 2008;8:958-969.
[27] S. Eshghjoo, D.M. Kim, A. Jayaraman, et al., Macrophage Polarization in Atherosclerosis,
Genes (Basel) 2022;13.
[28] S.C. Funes, M. Rios, J. Escobar-Vera, et al., Implications of macrophage polarization in
autoimmunity, Immunology 2018;154:186-195.
[29] S.Y. Kim, M.G. Nair, Macrophages in wound healing: activation and plasticity, Immunol
Cell Biol 2019;97:258-267.
[30] A. Shapouri-Moghaddam, S. Mohammadian, H. Vazini, et al., Macrophage plasticity,
polarization, and function in health and disease, J Cell Physiol 2018;233:6425-6440.
[31] Z. Cheng, Y.Z. Zhou, Y. Wu, et al., Diverse roles of macrophage polarization in aortic
aneurysm: destruction and repair, J Transl Med 2018;16:354.
[32] D. Hasan, N. Chalouhi, P. Jabbour, et al., Macrophage imbalance (M1 vs. M2) and
upregulation of mast cells in wall of ruptured human cerebral aneurysms: preliminary
results, Journal of neuroinflammation 2012;9:222.
[33] K. Shimizu, H. Kataoka, H. Imai, et al., Hemodynamic Force as a Potential Regulator of
Inflammation-Mediated Focal Growth of Saccular Aneurysms in a Rat Model, J Neuropathol
Exp Neurol 2021;80:79-88.
[34] K. Shimizu, H. Imai, A. Kawashima, et al., Induction of CCN1 in Growing Saccular
Aneurysms: A Potential Marker Predicting Unstable Lesions, J Neuropathol Exp Neurol
2021;80:695-704.
[35] I. Maldonado-Lasuncion, N. O'Neill, O. Umland, et al., Macrophage-Derived
21
Inflammation Induces a Transcriptome Makeover in Mesenchymal Stromal Cells Enhancing
Their Potential for Tissue Repair, Int J Mol Sci 2021;22.
[36] S. Yamada, A. Koizumi, H. Iso, et al., Risk factors for fatal subarachnoid hemorrhage:
the Japan Collaborative Cohort Study, Stroke; a journal of cerebral circulation 2003;34:27812787.
[37] K. Moazzami, M.T. Wittbrodt, B.B. Lima, et al., Higher Activation of the Rostromedial
Prefrontal Cortex During Mental Stress Predicts Major Cardiovascular Disease Events in
Individuals With Coronary Artery Disease, Circulation 2020;142:455-465.
[38] T. Aoki, M. Saito, H. Koseki, et al., Macrophage imaging of cerebral aneurysms with
ferumoxytol: an exploratory study in an animal model and in patients., Journal of Stroke and
Cerebrovascular Disease 2016.
[39] D.M. Hasan, K.B. Mahaney, V.A. Magnotta, et al., Macrophage imaging within human
cerebral aneurysms wall using ferumoxytol-enhanced MRI: a pilot study, Arteriosclerosis,
thrombosis, and vascular biology 2012;32:1032-1038.
[40] K. Shimizu, M. Kushamae, T. Aoki, Macrophage Imaging of Intracranial Aneurysms,
Neurol Med Chir (Tokyo) 2019;59:257-263.
Figure Legends
Fig. 1. The labeling of macrophages accumulating in aneurysm lesions in rats.
The labeling of macrophages accumulating in aneurysm lesions induced in the surgicallyformed bifurcation site induced in carotid artery of rats. The macroscopic view of the
aneurysm lesion induced in the surgically-formed bifurcation site induced in carotid
artery of rats is shown (a). The macrophages were labeled by the engulfment of liposome
containing fluorescent protein, DiI, were then visualized. The representative images of
22
accumulating macrophages in lesions from sections (b) or specimens with tissue
transparency (c) are shown. Dotted lines in (b) and (c) indicate the arterial walls or the
lesions. Scale Bars in (a), (b) or (c); 400 µm, 200 µm or 400 µm.
Fig. 2. Engulfing of DiI-containing liposome specifically by macrophages and the
dissection of macrophages by referencing DiI.
(a) Engulfing of DiI-containing liposome specifically by macrophages. HEK293 cells and
RAW264.7 cells were co-cultured and treated with DiI-containing liposome subjecting to
immunohistochemistry. The images from immunohistochemistry for the macrophage
marker, CD68 (green), the images of DiI (red), the nuclear staining by DAPI (blue) or the
merged images are shown. Scale bar; 50 µm. (b) The dissection of macrophages by lasermicrodissection technique. Macrophages were isolated by laser-microdissection
technique by referencing DiI. The images before or after the dissection are shown. Scale
bar; 10 µm.
Fig. 3. The identification of the unique macrophage subtype in aneurysm lesions at
the growth phase.
(a) The clustering analysis for gene expression profile in macrophages isolated from
23
aneurysm lesions at the growth phase. (b) The principal component analysis of gene
expression profile in macrophages isolated from aneurysm lesions, bone-marrow derived
M0 macrophages or M1 macrophages. (c, d) The heat map and the Venn diagram of overexpressed (c) or under-expressed genes (d) in macrophages isolated from aneurysm
lesions compared with that in bone-marrow derived M0 macrophages or M1 macrophages.
Fig. 4. The presence of nerves along arterial walls in bifurcation of intracranial
arteries.
The presence of myelinating nerves along arterial walls at bifurcation sites. The
bifurcation site of anterior cerebral artery – olfactory artery was harvested subjecting to
scanning electron microscopic examination and immunohistochemistry. The images from
the scanning electron microscopic examination (a) and the immunohistochemistry for the
smooth muscle cell marker, a-smooth muscle actin (red in b), the markers for Schwann
cells, S100 (gray in b) or Sox10 (green in b), and merged image with nuclear staining by
DAPI (blue in b) are shown (b). The magnified image corresponding to the square in the
upper panel is shown in the lower panel in (a). Scale bar; 50 µm.
24
Table 1. Up-represented terms in macrophages from aneurysm lesions at the growth phase
compared with in vitro-differentiated M0 from Biological Process and the top 15 list from
Molecular Function in gene ontology analysis.
Biological Process
P value
Sensory perception of taste
8.1E-05
Response to pheromone
2.8E-02
Neuropeptide signaling pathway
2.8E-02
Humoral immune response
2.8E-02
Antimicrobial humoral response
7.5E-02
Serotonin receptor signaling pathway
9.8E-02
Sensory perception of bitter taste
1.4E-01
Antimicrobial humoral immune response mediated by antimicrobial peptide
1.4E-01
G protein-coupled serotonin receptor signaling pathway
1.6E-01
Defense response to bacterium
1.6E-01
Molecular Function
P value
Odorant binding
1.4E-33
Pheromone receptor activity
8.2E-09
Neurotransmitter receptor activity
1.2E-06
Gated channel activity
1.8E-06
Channel activity
1.3E-05
Passive transmembrane transporter activity
1.3E-05
Hormone activity
1.9E-05
Ion channel activity
2.0E-05
G protein-coupled amine receptor activity
3.0E-05
G protein-coupled peptide receptor activity
3.0E-05
Postsynaptic neurotransmitter receptor activity
7.9E-05
Peptide receptor activity
7.9E-05
Ligand-gated ion channel activity
2.2E-04
Neuropeptide receptor activity
2.5E-04
Transmitter-gated ion channel activity
2.9E-04
Table 2. Up-represented terms in macrophages from aneurysm lesions at the growth phase
compared with in vitro-differentiated M1 from Biological Process and the top 15 list from
Molecular Function in gene ontology analysis.
Biological Process
P value
Sensory perception of taste
6.3E-04
Response to pheromone
3.4E-02
Neuropeptide signaling pathway
3.4E-02
Serotonin receptor signaling pathway
1.8E-01
Molecular Function
P value
Odorant binding
1.3E-33
Pheromone receptor activity
7.6E-09
Gated channel activity
4.9E-07
Neurotransmitter receptor activity
8.6E-07
Channel activity
6.4E-06
Passive transmembrane transporter activity
6.4E-06
Ion channel activity
9.6E-06
G protein-coupled amine receptor activity
1.4E-05
Hormone activity
1.9E-05
G protein-coupled peptide receptor activity
3.7E-05
Potassium channel activity
7.7E-05
Ligand-gated ion channel activity
7.7E-05
Postsynaptic neurotransmitter receptor activity
8.2E-05
Peptide receptor activity
9.3E-05
Transmitter-gated ion channel activity
1.1E-04
...