Edaravone, a free radical scavenger, protects components of the neurovascular unit against oxidative stress in vitro

Targeting the Nrf2-Keap1 antioxidant defence pathway for neurovascular protection in stroke

Endogenous defence mechanisms by which the brain protects itself against noxious stimuli and recovers from ischaemic damage are a key target of stroke research. The loss of viable brain tissue in the ischaemic core region after stroke is associated with damage to the surrounding area known as the penumbra. Activation of the redox-sensitive transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) plays a pivotal role in the cellular defence against oxidative stress via transcriptional upregulation of phase II defence enzymes and antioxidant stress proteins. Although recent evidence implicates Nrf2 in neuroprotection, it is not known whether activation of this pathway within the neurovascular unit protects the brain against blood-brain barrier breakdown and cerebrovascular inflammation. Targeting the neurovascular unit should provide novel insights for effective treatment strategies and facilitate translation of experimental findings into clinical therapy. This review focuses on the cytoprotective role of Nrf2 in stroke and examines the evidence that the Nrf2-Keap1 defence pathway may serve as a therapeutic target for neurovascular protection.

Free radical scavenger, edaravone, reduces the lesion size of lacunar infarction in human brain ischemic stroke

Background

Although free radicals have been reported to play a role in the expansion of ischemic brain lesions, the effect of free radical scavengers is still under debate. In this study, the temporal profile of ischemic stroke lesion sizes was assessed for more than one year to evaluate the effect of edaravone which might reduce ischemic damage.

Methods

We sequentially enrolled acute ischemic stroke patients, who admitted between April 2003 and March 2004, into the edaravone(-) group (n = 83) and, who admitted between April 2004 and March 2005, into the edaravone(+) group (n = 93). Because, edaravone has been used as the standard treatment after April 2004 in our hospital. To assess the temporal profile of the stroke lesion size, the ratio of the area [T2-weighted magnetic resonance images (T2WI)/iffusion-weighted magnetic resonance images (DWI)] were calculated. Observations on T2WI were continued beyond one year, and observational times were classified into subacute (1-2 months after the onset), early chronic (3-6 month), late chronic (7-12 months) and old (≥13 months) stages. Neurological deficits were assessed by the National Institutes of Health Stroke Scale upon admission and at discharge and by the modified Rankin Scale at 1 year following stroke onset.

Results

Stroke lesion size was significantly attenuated in the edaravone(+) group compared with the edaravone(-) group in the period of early and late chronic observational stages. However, this reduction in lesion size was significant within a year and only for the small-vessel occlusion stroke patients treated with edaravone. Moreover, patients with small-vessel occlusion strokes that were treated with edaravone showed significant neurological improvement during their hospital stay, although there were no significant differences in outcome one year after the stroke.

Conclusion

Edaravone treatment reduced the volume of the infarct and improved neurological deficits during the subacute period, especially in the small-vessel occlusion strokes.

Transcriptional upregulation of brain-derived neurotrophic factor in rostral ventrolateral medulla by angiotensin II: significance in superoxide homeostasis and neural regulation of arterial pressure

RATIONALE

Oxidative stress in rostral ventrolateral medulla (RVLM), where sympathetic premotor neurons for the maintenance of neurogenic vasomotor tone are located, contributes to neural mechanisms of hypertension. Emerging evidence suggests that brain-derived neurotrophic factor (BDNF) manifests "nontrophic" actions.

OBJECTIVE

We assessed the hypothesis that BDNF plays an active role in oxidative stress-associated neurogenic hypertension by maintaining superoxide anion (O⁻(.)₂) homeostasis in RVLM.

METHODS AND RESULTS

In Wistar-Kyoto rats, microinjection of angiotensin II (Ang II) bilaterally into RVLM upregulated BDNF mRNA and protein and induced cAMP response element binding protein (CREB) phosphorylation. The Ang II-induced BDNF upregulation in RVLM was attenuated by coadministration of the NADPH oxidase inhibitor apocynin; the superoxide dismutase mimetic tempol; or an antisense oligonucleotide against CREB. Intracisternal infusion of Ang II elicited phosphorylation of p47(phox) subunit of NADPH oxidase, suppression of mitochondrial electron coupling capacity, and augmentation in mitochondrial uncoupling protein (UCP)2 expression in RVLM. The former 2 cellular events were enhanced, whereas UCP2 upregulation was attenuated by gene knockdown of BDNF or depletion of tropomyosin receptor kinase (Trk)B ligands with recombinant human TrkB-Fc fusion protein. The same treatments also significantly potentiated both Ang II-induced (O⁻(.)₂) production in RVLM and chronic pressor response.

CONCLUSIONS

Ang II induces (O⁻(.)₂) -dependent upregulation of BDNF in RVLM via phosphorylation of CREB. The Ang II-activated BDNF/TrkB signaling, in turn, exerts negative-feedback regulation on tissue (O⁻(.)₂) level in RVLM through inhibition of p47(phox) phosphorylation, preservation of mitochondrial electron transport capacity, and upregulation of mitochondrial UCP2, resulting in protection against Ang II-induced oxidative stress and long-term pressor response.

A critical assessment of edaravone acute ischemic stroke efficacy trials: is edaravone an effective neuroprotective therapy?

IMPORTANCE OF THE FIELD

Edaravone (Radicut) is a free radical scavenger marketed in Japan by Mitsubishi Tanabe Pharma Corp. to treat acute ischemic stroke (AIS) patients presenting within 24 h of the attack. Injectable edaravone ampoules (30 mg b.i.d., i.v., 14 days) were first approved on 23 May 2001. On 19 January 2010, as a new innovation, the Radicut BAG (Intravenous BAG) was approved by the Japanese Ministry of Health and Welfare. Efficacy of edaravone ranges from large significant clinical improvements to only modest improvements in clinical function measured using standard stroke scales when administered 6-72 h following an ischemic stroke. With almost 17 years of edaravone clinical experience, a few adverse events--including acute renal failure--have been noted.

WHAT THE READER WILL GAIN

This is the only article to date to critically review available clinical efficacy and toxicology data published in the literature to ascertain whether edaravone should be further pursued as a candidate for development worldwide.

AREAS COVERED IN THIS REVIEW

This review covers clinical studies carried out over the period 1993-2008.

TAKE HOME MESSAGE

Edaravone may be a useful neuroprotective agent to treat the > 15 million victims worldwide who are devastated by stroke annually. Additional clinical studies are necessary to verify the efficacy of edaravone.

A novel method for inducing focal ischemia in vitro

Current in vitro models of stroke involve applying oxygen-glucose deprived (OGD) media over an entire brain slice or plate of cultured neurons. Thus, these models fail to mimic the focal nature of stroke as observed clinically and with in vivo rodent models of stroke. Our aim was to develop a novel in vitro brain slice model of stroke that would mimic focal ischemia and thus allow for the investigation of events occurring in the penumbra. This was accomplished by focally applying OGD medium to a small portion of a brain slice while bathing the remainder of the slice with normal oxygenated media. This technique produced a focal infarct on the brain slice that increased as a function of time. Electrophysiological recordings made within the flow of the OGD solution ("core") revealed that neurons rapidly depolarized (anoxic depolarization; AD) in a manner similar to that observed in other stroke models. Edaravone, a known neuroprotectant, significantly delayed this onset of AD. Electrophysiological recordings made outside the flow of the OGD solution ("penumbra") revealed that neurons within this region progressively depolarized throughout the 75 min of OGD application. Edaravone attenuated this depolarization and doubled neuronal survival. Finally, synaptic transmission in the penumbra was abolished within 50 min of focal OGD application. These results suggest that this in vitro model mimics events that occur during focal ischemia in vivo and can be used to determine the efficacy of therapeutics that target neuronal survival in the core and/or penumbra.