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England TJ, Sprigg N, Alasheev AM, Belkin AA, Kumar A, Prasad K, Bath PM. Granulocyte-Colony Stimulating Factor (G-CSF) for stroke: an individual patient data meta-analysis. Sci Rep 2016; 6:36567. [PMID: 27845349 PMCID: PMC5109224 DOI: 10.1038/srep36567] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022] Open
Abstract
Granulocyte colony stimulating factor (G-CSF) may enhance recovery from stroke through neuroprotective mechanisms if administered early, or neurorepair if given later. Several small trials suggest administration is safe but effects on efficacy are unclear. We searched for randomised controlled trials (RCT) assessing G-CSF in patients with hyperacute, acute, subacute or chronic stroke, and asked Investigators to share individual patient data on baseline characteristics, stroke severity and type, end-of-trial modified Rankin Scale (mRS), Barthel Index, haematological parameters, serious adverse events and death. Multiple variable analyses were adjusted for age, sex, baseline severity and time-to-treatment. Individual patient data were obtained for 6 of 10 RCTs comprising 196 stroke patients (116 G-CSF, 80 placebo), mean age 67.1 (SD 12.9), 92% ischaemic, median NIHSS 10 (IQR 5–15), randomised 11 days (interquartile range IQR 4–238) post ictus; data from three commercial trials were not shared. G-CSF did not improve mRS (ordinal regression), odds ratio OR 1.12 (95% confidence interval 0.64 to 1.96, p = 0.62). There were more patients with a serious adverse event in the G-CSF group (29.6% versus 7.5%, p = 0.07) with no significant difference in all-cause mortality (G-CSF 11.2%, placebo 7.6%, p = 0.4). Overall, G-CSF did not improve stroke outcome in this individual patient data meta-analysis.
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Affiliation(s)
- Timothy J England
- Vascular Medicine, Division of Medical Sciences and GEM, School of Medicine, University of Nottingham, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
| | | | - Andrey A Belkin
- Institute of Medical Cell Technologies, Yekaterinburg, Russia
| | - Amit Kumar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
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Wouters A, Lemmens R, Christensen S, Wilms G, Dupont P, Mlynash M, Schneider A, Laage R, Cereda CW, Lansberg MG, Albers GW, Thijs V. Magnetic resonance imaging-based endovascular versus medical stroke treatment for symptom onset up to 12 h. Int J Stroke 2016; 11:127-33. [PMID: 26763028 DOI: 10.1177/1747493015607503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent trials have shown a clear benefit of endovascular therapy for stroke patients presenting within 6 h after stroke onset. Imaging-based selection may identify a cohort with a favorable response to endovascular therapy, in an even later time window. AIMS We performed an indirect comparison between outcomes seen in DEFUSE 2, a prospective cohort study of patients who received a baseline MRI before endovascular therapy, and a control group from AXIS 2 receiving standard medical care up to 12 h after symptom onset. METHODS Patients from AXIS 2 with a confirmed large vessel occlusion were selected as a control group for DEFUSE 2-patients. The primary endpoint was good functional outcome at day 90 (Modified Rankin Score 0-2). We performed a stratified analysis based on the presence of the target mismatch for both studies and reperfusion status in DEFUSE 2. RESULTS We compared good functional outcome in 108 patients from AXIS 2 and 99 patients from DEFUSE 2. In DEFUSE 2-patients with the target mismatch profile in whom reperfusion was achieved, the rate of good functional outcome was increased compared to target mismatch patients in AXIS 2, 54% versus 29% (OR 3.2, 95% CI 1.1-9.4). In target mismatch patients treated between 6 and 12 h after stroke onset, this association between study and good functional outcome remained present (OR 9.0, 95% CI 1.1-75.8). CONCLUSIONS This indirect comparison suggests that endovascular treatment resulting in substantial reperfusion is associated with improved outcome in target mismatch patients even beyond 6 h after stroke onset. Confirmation is needed from future clinical trials that randomize patients beyond the 6 h time window.
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Affiliation(s)
- Anke Wouters
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Robin Lemmens
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | | | - Guido Wilms
- Department of Radiology, University Hospitals of Leuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Epilepsy Research, Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium Medical Imaging Research Center, UZ Leuven, Leuven, Belgium
| | | | | | - Rico Laage
- GUIDED Development Heidelberg GmbH, Heidelberg, Germany
| | - Carlo W Cereda
- Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | | | - Vincent Thijs
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium University Hospitals Leuven, Department of Neurology, Leuven, Belgium
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Kasahara Y, Yamahara K, Soma T, Stern DM, Nakagomi T, Matsuyama T, Taguchi A. Transplantation of hematopoietic stem cells: intra-arterial versus intravenous administration impacts stroke outcomes in a murine model. Transl Res 2016; 176:69-80. [PMID: 27164406 DOI: 10.1016/j.trsl.2016.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/31/2016] [Accepted: 04/09/2016] [Indexed: 11/27/2022]
Abstract
Based on results of hematopoietic stem cell transplantation in animal models of stroke, clinical trials with hematopoietic stem cells administered intra-arterially or intravenously have been initiated in patients. Although intra-arterial injection is expected to deliver transplanted cells more directly to the ischemic tissue, the optimal route for enhancing clinical outcomes has not been identified in the setting of stroke. In this study, we compared the therapeutic potential of intra-arterial versus intravenous injection of bone marrow derived-mononuclear cells (BM-MNCs) and CD133-positive (CD133(+)) cells in a murine stroke model. We have found that intra-arterial injection of BM-MNCs exaggerates inflammation with accompanying loss of microvascular structures in poststroke brain and no improvement in cortical function. In contrast, intravenous injection of BM-MNCs did not similarly enhance inflammation and improved cortical function. Our results indicate that the optimal route of cell transplantation can vary with different cell populations and highlight possible issues that might arise with intra-arterial cell administration for acute ischemic cerebrovascular disease.
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Affiliation(s)
- Yukiko Kasahara
- Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Kenichi Yamahara
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Toshihiro Soma
- Department of Hematology, Hyogo College of Medicine, Nishinomiya, Japan
| | - David M Stern
- Executive Dean's office, University of Tennessee, Tennessee, USA
| | - Takayuki Nakagomi
- Department of Neurogenesis and CNS repair, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomohiro Matsuyama
- Department of Neurogenesis and CNS repair, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akihiko Taguchi
- Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation, Kobe, Japan.
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Wouters A, Dupont P, Norrving B, Laage R, Thomalla G, Albers GW, Thijs V, Lemmens R. Prediction of Stroke Onset Is Improved by Relative Fluid-Attenuated Inversion Recovery and Perfusion Imaging Compared to the Visual Diffusion-Weighted Imaging/Fluid-Attenuated Inversion Recovery Mismatch. Stroke 2016; 47:2559-64. [DOI: 10.1161/strokeaha.116.013903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4.5 hours could be improved by including various clinical and imaging parameters.
Methods—
In this study, 141 patients in whom magnetic resonance imaging was obtained within 9 hours after symptom onset were included. Relative FLAIR signal intensity was calculated in the region of nonreperfused core. Mean
T
max
was calculated in the total region with
T
max
>6 s. Mean relative FLAIR, mean
T
max
, lesion volume with
T
max
>6 s, age, site of arterial stenosis, core volume, and location of infarct were analyzed by logistic regression to predict stroke onset time before or after 4.5 hours.
Results—
Receiver-operating characteristic curve analysis revealed an area under the curve of 0.68 (95% confidence interval 0.59–0.78) for the visual diffusion-weighted imaging/FLAIR mismatch, thereby correctly classifying 69% of patients with an onset time before or after 4.5 hours. Age, relative FLAIR, and
T
max
increased the accuracy significantly (
P
<0.01) to an area under the curve of 0.82 (95% confidence interval 0.74–0.89). This new predictive model correctly categorized 77% of patients according to stroke onset before versus after 4.5 hours.
Conclusions—
In patients with unknown stroke onset, the accuracy of predicting time from symptom onset within 4.5 hours is improved by obtaining relative FLAIR and perfusion imaging.
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Affiliation(s)
- Anke Wouters
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Patrick Dupont
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Bo Norrving
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Rico Laage
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Götz Thomalla
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Gregory W. Albers
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Vincent Thijs
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Robin Lemmens
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
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Granulocyte Colony Stimulating Factor and Physiotherapy after Stroke: Results of a Feasibility Randomised Controlled Trial: Stem Cell Trial of Recovery EnhanceMent after Stroke-3 (STEMS-3 ISRCTN16714730). PLoS One 2016; 11:e0161359. [PMID: 27610616 PMCID: PMC5017715 DOI: 10.1371/journal.pone.0161359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/04/2016] [Indexed: 01/19/2023] Open
Abstract
Background Granulocyte-colony stimulating factor (G-CSF) mobilises endogenous haematopoietic stem cells and enhances recovery in experimental stroke. Recovery may also be dependent on an enriched environment and physical activity. G-CSF may have the potential to enhance recovery when used in combination with physiotherapy, in patients with disability late after stroke. Methods A pilot 2 x 2 factorial randomised (1:1) placebo-controlled trial of G-CSF (double-blind), and/or a 6 week course of physiotherapy, in 60 participants with disability (mRS >1), at least 3 months after stroke. Primary outcome was feasibility, acceptability and tolerability. Secondary outcomes included death, dependency, motor function and quality of life measured 90 and 365 days after enrolment. Results Recruitment to the trial was feasible and acceptable; of 118 screened patients, 92 were eligible and 32 declined to participate. 60 patients were recruited between November 2011 and July 2013. All participants received some allocated treatment. Although 29 out of 30 participants received all 5 G-CSF/placebo injections, only 7 of 30 participants received all 18 therapy sessions. G-CSF was well tolerated but associated with a tendency to more adverse events than placebo (16 vs 10 patients, p = 0.12) and serious adverse events (SAE) (9 vs 3, p = 0.10). On average, patients received 14 (out of 18 planned) therapy sessions, interquartile range [12, 17]. Only a minority (23%) of participants completed all physiotherapy sessions, a large proportion of sessions (114 of 540, 21%) were cancelled due to patient (94, 17%) and therapist factors (20, 4%). No significant differences in functional outcomes were detected in either the G-CSF or physiotherapy group at day 90 or 365. Conclusions Delivery of G-CSF is feasible in chronic stroke. However, the study failed to demonstrate feasibility for delivering additional physiotherapy sessions late after stroke therefore a definitive study using this trial design is not supported. Future work should occur earlier after stroke, alongside on-going clinical rehabilitation. Trial Registration ISRCTN.com ISRCTN16714730
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Nguyen TVV, Frye JB, Zbesko JC, Stepanovic K, Hayes M, Urzua A, Serrano G, Beach TG, Doyle KP. Multiplex immunoassay characterization and species comparison of inflammation in acute and non-acute ischemic infarcts in human and mouse brain tissue. Acta Neuropathol Commun 2016; 4:100. [PMID: 27600707 PMCID: PMC5011964 DOI: 10.1186/s40478-016-0371-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/19/2016] [Indexed: 12/12/2022] Open
Abstract
This study provides a parallel characterization of the cytokine and chemokine response to stroke in the human and mouse brain at different stages of infarct resolution. The study goal was to address the hypothesis that chronic inflammation may contribute to stroke-related dementia. We used C57BL/6 and BALB/c mice to control for strain related differences in the mouse immune response. Our data indicate that in both mouse strains, and humans, there is increased granulocyte macrophage colony-stimulating factor (GM-CSF), interleukin-6 (IL-6), interleukin-12 p70 (IL-12p70), interferon gamma-induced protein-10 (IP-10), keratinocyte chemoattractant/interleukin-8 (KC/IL-8), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), macrophage inflammatory protein-1β (MIP-1β), regulated on activation, normal T cell expressed and secreted (RANTES), and Tumor necrosis factor-α (TNF-α) in the infarct core during the acute time period. Nevertheless, correlation and two-way ANOVA analyses reveal that despite this substantial overlap between species, there are still significant differences, particularly in the regulation of granulocyte colony-stimulating factor (G-CSF), which is increased in mice but not in humans. In the weeks after stroke, during the stage of liquefactive necrosis, there is significant resolution of the inflammatory response to stroke within the infarct. However, CD68+ macrophages remain present, and levels of IL-6 and MCP-1 remain chronically elevated in infarcts from both mice and humans. Furthermore, there is a chronic T cell response within the infarct in both species. This response is differentially polarized towards a T helper 1 (Th1) response in C57BL/6 mice, and a T helper 2 (Th2) response in BALB/c mice, suggesting that the chronic inflammatory response to stroke may follow a different trajectory in different patients. To control for the fact that the average age of the patients used in this study was 80 years, they were of both sexes, and many had suffered from multiple strokes, we also present findings that reveal how the chronic inflammatory response to stroke is impacted by age, sex, and multiple strokes in mice. Our data indicate that the chronic cytokine and chemokine response to stroke is not substantially altered in 18-month old compared to 3-month old C57BL/6 mice, although T cell infiltration is attenuated. We found a significant correlation in the chronic cytokine response to stroke in males and females. However, the chronic cytokine response to stroke was mildly exacerbated by a recurrent stroke in both C57BL/6 and BALB/c mice.
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Unsworth DJ, Mathias JL, Dorstyn DS. Safety and efficacy of cell therapies administered in the acute and subacute stages after stroke: a meta-analysis. Regen Med 2016; 11:725-41. [PMID: 27580670 DOI: 10.2217/rme-2016-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To evaluate the safety and efficacy of cell therapies administered acutely/sub-acutely after stroke. METHODS Five databases were searched for studies examining the safety/efficacy of cell therapies administered ≤90 days post-stroke. Reporting quality and adherence to research guidelines were evaluated. Safety and efficacy were assessed using risk ratios/pooled incidence rates and Hedge's g, respectively. RESULTS 11 therapies (Nstudies= 28) were trialed: reporting quality was high, but adherence to guidelines low. Serious adverse events were observed following five treatments; six improved outcomes. There was a trend toward larger treatment effects in non-blinded studies, younger participants, and higher dosages. CONCLUSION Although a number of therapies appear effective, many studies did not control for normal recovery (standard-care). Long-term safety also needs to be established.
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Affiliation(s)
- David J Unsworth
- Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane L Mathias
- Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Diana S Dorstyn
- Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
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Peña ID, Borlongan CV. Translating G-CSF as an Adjunct Therapy to Stem Cell Transplantation for Stroke. Transl Stroke Res 2016; 6:421-9. [PMID: 26482176 DOI: 10.1007/s12975-015-0430-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 01/26/2023]
Abstract
Among recently investigated stroke therapies, stem cell treatment holds great promise by virtue of their putative ability to replace lost cells, promote endogenous neurogenesis,and produce behavioral and functional improvement through their "bystander effects." Translating stem cell in the clinic, however, presents a number of technical difficulties. A strategy suggested to enhance therapeutic utility of stem cells is combination therapy, i.e., co-transplantation of stem cells or adjunct treatment with pharmacological agents and substrates,which is assumed to produce more profound therapeutic benefits by circumventing limitations of individual treatments and facilitating complementary brain repair processes. We previously demonstrated enhanced functional effects of cotreatment with granulocyte-colony stimulating factor (GCSF)and human umbilical cord blood cell (hUCB) transplantation in animal models of traumatic brain injury (TBI). Here,we suggest that the aforementioned combination therapy may also produce synergistic effects in stroke. Accordingly, G-CSF treatment may reduce expression of pro-inflammatory cytokines and enhance neurogenesis rendering a receptive microenvironment for hUCB engraftment. Adjunct treatment of GCSF with hUCB may facilitate stemness maintenance and guide neural lineage commitment of hUCB cells. Moreover, regenerative mechanisms afforded by G-CSF-mobilized endogenous stem cells, secretion of growth factors by hUCB grafts and G-CSF-recruited endothelial progenitor cells(EPCs), as well as the potential graft–host integration that may promote synaptic circuitry re-establishment could altogether produce more pronounced functional improvement in stroked rats subjected to a combination G-CSF treatment and hUCB transplantation. Nevertheless, differences in pathology and repair processes underlying TBI and stroke deserve consideration when testing the effects of combinatorial G-CSF and hUCB cell transplantation for stroke treatment. Further studies are also required to determine the safety and efficacy of this intervention in both preclinical and clinical stroke studies.
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Abstract
Cytokines are a heterogeneous group of glycoproteins that coordinate physiological functions. Cytokine deregulation is observed in many neurological diseases. This article reviews current research focused on human clinical trials of cytokine and anticytokine therapies in the treatment of several neurological disease including stroke, neuromuscular diseases, neuroinfectious diseases, demyelinating diseases, and neurobehavioral diseases. This research suggests that cytokine therapy applications may play an important role in offering new strategies for disease modulation and treatment. Further, this research provides insights into the causal link between cytokine deregulation and neurological diseases.
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Affiliation(s)
- Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA.
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Song S, Kong X, Acosta S, Sava V, Borlongan C, Sanchez-Ramos J. Granulocyte-colony stimulating factor promotes brain repair following traumatic brain injury by recruitment of microglia and increasing neurotrophic factor expression. Restor Neurol Neurosci 2016; 34:415-31. [DOI: 10.3233/rnn-150607] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Shijie Song
- James A Haley VAH Research Service, Tampa FL, USA
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Xiaoyuan Kong
- James A Haley VAH Research Service, Tampa FL, USA
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Sandra Acosta
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Vasyl Sava
- James A Haley VAH Research Service, Tampa FL, USA
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Cesar Borlongan
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Juan Sanchez-Ramos
- James A Haley VAH Research Service, Tampa FL, USA
- Department of Neurology, University of South Florida, Tampa, FL, USA
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Zhang L, Huang Y, Lin Y, Shan Y, Tan S, Cai W, Li H, Zhang B, Men X, Lu Z. Anti-inflammatory effect of cholera toxin B subunit in experimental stroke. J Neuroinflammation 2016; 13:147. [PMID: 27296014 PMCID: PMC4906956 DOI: 10.1186/s12974-016-0610-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/02/2016] [Indexed: 12/20/2022] Open
Abstract
Background Cholera toxin B subunit (CTB) has multifaceted immunoregulatory functions. Immunity plays an important role in the mechanism of stroke. However, little is known about whether CTB is beneficial for stroke. Methods CTB was administered intraperitoneally after ischemia to rats subjected to transient focal ischemia. Infarct volumes, body weight loss, and neurologic deficits were measured. Cytokines, microglia/macrophage activation, and transcriptional factors in the ischemic brain were tested. The mRNA expressions of IL-1β and TNF-α were tested in the microglia/macrophage isolated from the ischemic hemisphere. γδT cells, IL-17-producing γδT cells, Th17 cells, and regulatory T (Treg) cells in the ischemic brain were tested. γδT cells and Treg cells in the peripheral blood were also evaluated. Results CTB reduced infarct volumes, neurologic deficits, and body weight loss after ischemia. At 24 h after ischemia, CTB downregulated the levels of IL-1β, TNF-α, NF-kB p65, phosphorylated-ERK1/2, and microglia/macrophage activation and suppressed NF-kB binding activity, but did not affect the level of ERK1/2. The mRNA expressions of IL-1β and TNF-α in the microglia/macrophage isolated from the ischemic hemisphere were suppressed after CTB therapy. In the ischemic hemisphere, CTB treatment reduced the levels of γδT cells, IL-17-producing γδT cells, and IL-17 at both 24 and 72 h after ischemia, while Th17 cells were not affected. After CTB treatment, the levels of Treg cells, TGF-β, and IL-10 remained unchanged at 24 h and upregulated at 72 h after ischemia. Inactivation of Treg cells using anti-CD25 attenuated the increase of TGF-β and IL-10 induced by CTB at 72 h after ischemia. In the peripheral blood, CTB increased Treg cells and suppressed γδT cells at 24 h after ischemia. And then at 72 h after ischemia, it increased Treg cells but did not impact γδT cells. CTB had no effect on cytokines, transcription factors, infiltrating γδT cells, and Treg cells in the brain of shams. In the peripheral blood of shams, CTB increased Treg cells at both 24 and 72 h, while it did not affect γδT cells. Conclusions CTB decreased neurologic impairment and tissue injury after cerebral ischemia via its immunomodulatory functions, including inhibiting microglia/macrophage activation, suppressing γδT cells, and inducing production of Treg cells, thus regulating the secretion of related cytokines. Suppression of NF-kB and ERK1/2 pathways is involved in the neuroprotective mechanism of CTB.
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Affiliation(s)
- Lei Zhang
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihuadong Road, Zhuhai City, China.,Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Yanxia Huang
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 Meihuadong Road, Zhuhai City, China
| | - Yinyao Lin
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Sha Tan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Haiyan Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Xuejiao Men
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou City, China.
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Mizuma A, Yamashita T, Kono S, Nakayama T, Baba Y, Itoh S, Asakura K, Niimi Y, Asahi T, Kanemaru K, Mutoh T, Kuroda S, Kinouchi H, Abe K, Takizawa S. Phase II Trial of Intravenous Low-Dose Granulocyte Colony-Stimulating Factor in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:1451-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 01/03/2023] Open
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Secades JJ, Alvarez-Sabín J, Castillo J, Díez-Tejedor E, Martínez-Vila E, Ríos J, Oudovenko N. Citicoline for Acute Ischemic Stroke: A Systematic Review and Formal Meta-analysis of Randomized, Double-Blind, and Placebo-Controlled Trials. J Stroke Cerebrovasc Dis 2016; 25:1984-96. [PMID: 27234918 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Citicoline is a drug approved for the treatment of acute ischemic stroke. Although evidence of its efficacy has been reported, recently published results of a large placebo-controlled clinical trial did not show differences. This study aims to assess whether starting citicoline treatment within 14 days after stroke onset improves the outcome in patients with acute ischemic stroke, as compared with placebo. METHODS A systematic search was performed to identify all published, unconfounded, randomized, double-blind, and placebo-controlled clinical trials of citicoline in acute ischemic stroke. RESULTS Ten randomized clinical trials met our inclusion criteria. The administration of citicoline was associated with a significant higher rate of independence, independently of the method of evaluation used (odds ratio [OR] 1.56, 95% confidence interval [CI] = 1.12-2.16 under random effects; OR 1.20, 95% CI = 1.06-1.36 under fixed effects). After studying the cumulative meta-analysis, and with the results obtained with the subgroup of patients who were not treated with recombinant tissue plasminogen activator (rtPA) (OR 1.63, 95% CI = 1.18-2.24 under random effects; OR 1.42, 95% CI = 1.22-1.66 under fixed effects), our hypothesis of dilution of the effect of citicoline was confirmed. When we analyzed the effect of citicoline in patients who were not treated with rtPA and were receiving the highest dose of citicoline started in the first 24 hours after onset, based on more recent trials, there was no heterogeneity, and the size of the effect has an OR of 1.27 (95% CI = 1.05-1.53). CONCLUSIONS This systematic review supports some benefits of citicoline in the treatment of acute ischemic stroke. But, on top of the best treatment available (rtPA), citicoline offers a limited benefit.
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Affiliation(s)
| | - José Alvarez-Sabín
- Department of Neurology, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - José Castillo
- Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Centre, Hospital Universitario La Paz, Madrid, Spain
| | | | - José Ríos
- Biostatistics and Data Management Core Facility, IDIBAPS (Hospital Clinic), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Beristain X, Golombievski E. Pharmacotherapy to Enhance Cognitive and Motor Recovery Following Stroke. Drugs Aging 2016; 32:765-72. [PMID: 26423272 DOI: 10.1007/s40266-015-0299-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is a leading cause of disability among older adults and more than half of stroke survivors have some residual neurological impairment. Traditionally, managing the aftermath of stroke has been by the implementation of several physical and language therapy modalities. The limitations of these rehabilitation efforts have sparked an interest in finding other ways to enhance neurological recovery. Some of these novel approaches have included pharmacological interventions, cell-derived treatments, and cortical magnetic stimulation. Mounting evidence over the last 2 decades suggests that pharmacological manipulations may have the potential to modulate practice-dependent neuroplasticity and potentially improve neurological recovery after stroke. Multiple pharmacological agents with different mechanisms of action have been evaluated, showing conflicting results. Some studies suggest some promise, yet the quality of the available studies is suboptimal overall, with most of the studies being underpowered. So far, the most promising agents include the antidepressants for motor recovery and acetylcholinesterase inhibitors and memantine for aphasia. However, large, well-designed clinical trials are needed to address the shortcomings of the available data and before any pharmacological agent can be recommended for routine use as part of the standard algorithm of stroke management.
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Affiliation(s)
- Xabier Beristain
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, Maguire Building, #2700, 2160 South 1st Avenue, Maywood, IL, 60153, USA.
| | - Esteban Golombievski
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, Maguire Building, #2700, 2160 South 1st Avenue, Maywood, IL, 60153, USA
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Carmichael ST. Emergent properties of neural repair: elemental biology to therapeutic concepts. Ann Neurol 2016; 79:895-906. [PMID: 27043816 PMCID: PMC4884133 DOI: 10.1002/ana.24653] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 12/20/2022]
Abstract
Stroke is the leading cause of adult disability. The past decade has seen advances in basic science research of neural repair in stroke. The brain forms new connections after stroke, which have a causal role in recovery of function. Brain progenitors, including neuronal and glial progenitors, respond to stroke and initiate a partial formation of new neurons and glial cells. The molecular systems that underlie axonal sprouting, neurogenesis, and gliogenesis after stroke have recently been identified. Importantly, tractable drug targets exist within these molecular systems that might stimulate tissue repair. These basic science advances have taken the field to its first scientific milestone; the elemental principles of neural repair in stroke have been identified. The next stages in this field involve understanding how these elemental principles of recovery interact in the dynamic cellular systems of the repairing brain. Emergent principles arise out of the interaction of the fundamental or elemental principles in a system. In neural repair, the elemental principles of brain reorganization after stroke interact to generate higher order and distinct concepts of regenerative brain niches in cellular repair, neuronal networks in synaptic plasticity, and the distinction of molecular systems of neuroregeneration. Many of these emergent principles directly guide the development of new therapies, such as the necessity for spatial and temporal control in neural repair therapy delivery and the overlap of cancer and neural repair mechanisms. This review discusses the emergent principles of neural repair in stroke as they relate to scientific and therapeutic concepts in this field. Ann Neurol 2016;79:895–906
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Affiliation(s)
- S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA and UCLA Broad Stem Cell Center, University of California, Los Angeles, Los Angeles, CA
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Feldman WB, Kim AS, Josephson SA, Lowenstein DH, Chiong W. Effect of waivers of consent on recruitment in acute stroke trials: A systematic review. Neurology 2016; 86:1543-51. [PMID: 27009262 PMCID: PMC4836887 DOI: 10.1212/wnl.0000000000002587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/16/2015] [Indexed: 01/08/2023] Open
Abstract
There is urgent need for clinical trials of novel interventions to reduce the burden of acute ischemic stroke. A key impediment to such trials is slow recruitment. Since obtaining written informed consent in the setting of acute stroke is especially challenging, some experts have endorsed relaxing the requirement for informed consent by permitting verbal consent or waivers to facilitate recruitment. This systematic review of 36 randomized controlled trials of acute interventions for ischemic stroke assesses whether alternatives to written informed consent are associated with increased recruitment rates. After the exclusion of 2 outlier trials that differed from other trials in conduct and interventions studied, no association was observed on univariable analysis (8.9 participants/month in trials requiring written consent vs 6.1 participants/month in trials with alternatives, p = 0.43) or multivariable analysis (when adjusting for the number of centers, number of countries, and exclusions based on modified Rankin Scale scores). Alternatives to written informed consent in acute stroke trials may enable trial designs that would not be feasible otherwise. However, we did not find evidence that, within traditional trial designs, such alternatives are associated with faster recruitment.
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Affiliation(s)
- William B Feldman
- From the School of Medicine (W.B.F.), Department of Neurology (A.S.K., S.A.J., D.H.L., W.C.), and Memory and Aging Center (W.C.), University of California, San Francisco.
| | - Anthony S Kim
- From the School of Medicine (W.B.F.), Department of Neurology (A.S.K., S.A.J., D.H.L., W.C.), and Memory and Aging Center (W.C.), University of California, San Francisco
| | - S Andrew Josephson
- From the School of Medicine (W.B.F.), Department of Neurology (A.S.K., S.A.J., D.H.L., W.C.), and Memory and Aging Center (W.C.), University of California, San Francisco
| | - Daniel H Lowenstein
- From the School of Medicine (W.B.F.), Department of Neurology (A.S.K., S.A.J., D.H.L., W.C.), and Memory and Aging Center (W.C.), University of California, San Francisco
| | - Winston Chiong
- From the School of Medicine (W.B.F.), Department of Neurology (A.S.K., S.A.J., D.H.L., W.C.), and Memory and Aging Center (W.C.), University of California, San Francisco
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Du XL, Zhang Y, Hardy D. Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer. Cancer Causes Control 2016; 27:695-707. [PMID: 27059219 DOI: 10.1007/s10552-016-0742-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/29/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the risk of venous thromboembolism (VTE), stroke, ischemic heart disease, and myelodysplastic syndrome (MDS) in association with the receipt of colony-stimulating factors (CSFs) and/or erythropoiesis-stimulating agents (ESAs) in women with breast cancer. METHODS We studied 77,233 women with breast cancer aged ≥65 in 1992-2009 from the Surveillance, Epidemiology, and End Results-Medicare linked data with up to 19 years of follow-up. RESULTS Incidence of VTE increased from 9 cases in women receiving no chemotherapy and no CSFs/ESAs to 22.79 cases per 1,000 person-years in those receiving chemotherapy with CSFs and ESAs. Women with chemotherapy who received both CSFs and ESAs (adjusted hazard ratio and 95 % confidence interval 2.01, 1.80-2.25) or received ESAs without CSFs (2.03, 1.74-2.36) were twice as likely to develop VTE than those receiving no chemotherapy and no CSFs/ESAs, whereas those receiving CSF alone without ESA were 64 % more likely to have VTE (1.64, 1.45-1.85). Risk of MDS was significantly increased by fivefold in patients receiving ESA following chemotherapy. CONCLUSIONS Receipts of CSFs and ESAs were significantly associated with an increased risk of VTE in women with breast cancer. Use of ESAs was significantly associated with substantially increased risks of MDS. These findings support those of previous studies.
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Affiliation(s)
- Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA. .,Center for Health Services Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Yefei Zhang
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, USA.,Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dale Hardy
- Department of Clinical and Environmental Health Sciences, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
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Wouters A, Dupont P, Christensen S, Norrving B, Laage R, Thomalla G, Albers G, Thijs V, Lemmens R. Association Between Time From Stroke Onset and Fluid-Attenuated Inversion Recovery Lesion Intensity Is Modified by Status of Collateral Circulation. Stroke 2016; 47:1018-22. [PMID: 26917566 DOI: 10.1161/strokeaha.115.012010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In patients with acute stroke, the intensity of a fluid-attenuated inversion recovery (FLAIR) lesion in the region of diffusion restriction is associated with time from symptom onset. We hypothesized that collateral status as assessed by the hypoperfusion intensity ratio could modify the association between time from stroke onset and FLAIR lesion intensity. METHODS From the AX200 for ischemic stroke trial, 141 patients had appropriate FLAIR, diffusion-weighted imaging, and perfusion-weighted imaging. In the region of nonreperfused core, we calculated voxel-based relative FLAIR (rFLAIR) signal intensity. The hypoperfusion intensity ratio was defined as the ratio of the Tmax >10 s lesion over the Tmax >6 s lesion volume. A hypoperfusion intensity ratio threshold of ≤0.4 was used to dichotomize good versus poor collaterals. We studied the interaction between collateral status on the association between time from symptom onset and FLAIR intensity. RESULTS Time from symptom onset was associated with the rFLAIR intensity in the region of nonreperfused core (B=1.05; 95% confidence interval, 1.0-1.1). We identified an interaction between this association and collateral status; an association was present between time and rFLAIR intensity in patients with poor collaterals (r=0.53), but absent in patients with good collaterals (r=0.17; P=0.04). CONCLUSIONS Our findings show that the relationship between time from symptom onset and rFLAIR lesion intensity depends on collateral status. In patients with good collaterals, the development of an rFLAIR-positive lesion is less dependent on time from symptom onset compared with patients with poor collaterals.
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Affiliation(s)
- Anke Wouters
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.).
| | - Patrick Dupont
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Soren Christensen
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Bo Norrving
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Rico Laage
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Götz Thomalla
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Greg Albers
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Vincent Thijs
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
| | - Robin Lemmens
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium (A.W., R.L.); Laboratory of Neurobiology, VIB, Vesalius Research Center, Leuven, Belgium (A.W., R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (A.W., R.L.); Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium (P.D.); Department of Neurology, Stroke Center, Stanford University, Palo Alto, CA (S.C., G.A.); Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden (B.N.); Guided Development GmbH, Heidelberg, Germany (R.L.); Uinversitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf-und Neurozentrum, Hamburg, Germany (G.T.); and Department of Neurology Austin Health, Melbourne Brain Center, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (V.T.)
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Endothelial CD36 Contributes to Postischemic Brain Injury by Promoting Neutrophil Activation via CSF3. J Neurosci 2016; 35:14783-93. [PMID: 26538649 DOI: 10.1523/jneurosci.2980-15.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED The scavenger receptor CD36 is a critical factor initiating ischemic brain injury, but the cell type(s) expressing CD36 and responsible for its harmful effects remain unknown. Using bone marrow (BM) chimeras subjected to transient middle cerebral artery occlusion, we found that CD36(-/-) mice transplanted with wild-type (WT) BM (WT→CD36(-/-)) have smaller infarcts (-67%), comparable with those of mice lacking CD36 both in brain and hematogenous cells (CD36(-/-) →CD36(-/-); - 72%). Conversely, WT mice receiving CD36(-/-) BM (CD36(-/-) →WT) have infarcts similar to WT→WT mice, suggesting that CD36 in the host brain (i.e., in microglia and endothelial cells), and not in hematogenous cells is involved in the damage. As anticipated, postischemic neutrophil infiltration in CD36(-/-) →CD36(-/-) mice was attenuated. Surprisingly, however, in WT→CD36(-/-) mice, in which infarcts were small, neutrophil infiltration was large and similar to that of CD36(-/-) →WT mice, in which infarcts were not reduced. Postischemic neutrophil free radical production was attenuated in WT→CD36(-/-) mice compared with CD36(-/-) →WT mice, whereas expression of the neutrophil activator colony-stimulating factor 3 (CSF3) was suppressed in CD36(-/-) cerebral endothelial cells, but not microglia. In CD36(-/-) cerebral endothelial cultures exposed to extracts from stroke brains, the upregulation of CSF3, but not neutrophil attractant chemokines, was suppressed. Intracerebroventricular administration of CSF3, 24 h after stroke, reconstituted neutrophil radical production and increased infarct volume in WT→CD36(-/-) mice. The findings identify endothelial cells as a key player in the deleterious effects of CD36 in stroke, and unveil a novel role of endothelial CD36 in enabling neutrophil neurotoxicity through CSF3. SIGNIFICANCE STATEMENT Ischemic stroke is a leading cause of death and disability worldwide with limited therapeutic options. The inflammatory response initiated by cerebral ischemia-reperfusion contributes to ischemic brain injury and is a potential therapeutic target. Here we report that CD36, an innate immunity receptor involved in the initiation of postischemic inflammation, is a previously unrecognized regulator of neutrophil cytotoxicity. The effect is mediated by endothelial CD36 via upregulation of the neutrophil activator CSF3 in cerebral endothelial cells. Therefore, approaches to modulate cerebral endothelial CD36 signaling or to neutralize CSF3 may provide novel therapeutic opportunities to ameliorate postischemic inflammatory injury.
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Strecker JK, Olk J, Hoppen M, Gess B, Diederich K, Schmidt A, Schäbitz WR, Schilling M, Minnerup J. Combining Growth Factor and Bone Marrow Cell Therapy Induces Bleeding and Alters Immune Response After Stroke in Mice. Stroke 2016; 47:852-62. [PMID: 26839353 DOI: 10.1161/strokeaha.115.011230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/31/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Bone marrow cell (BMC)-based therapies, either the transplantation of exogenous cells or stimulation of endogenous cells by growth factors like the granulocyte colony-stimulating factor (G-CSF), are considered a promising means of treating stroke. In contrast to large preclinical evidence, however, a recent clinical stroke trial on G-CSF was neutral. We, therefore, aimed to investigate possible synergistic effects of co-administration of G-CSF and BMCs after experimental stroke in mice to enhance the efficacy compared with single treatments. METHODS We used an animal model for experimental stroke as paradigm to study possible synergistic effects of co-administration of G-CSF and BMCs on the functional outcome and the pathophysiological mechanism. RESULTS G-CSF treatment alone led to an improved functional outcome, a reduced infarct volume, increased blood vessel stabilization, and decreased overall inflammation. Surprisingly, the combination of G-CSF and BMCs abrogated G-CSFs' beneficial effects and resulted in increased hemorrhagic infarct transformation, altered blood-brain barrier, excessive astrogliosis, and altered immune cell polarization. These increased rates of infarct bleeding were mainly mediated by elevated matrix metalloproteinase-9-mediated blood-brain barrier breakdown in G-CSF- and BMCs-treated animals combined with an increased number of dilated and thus likely more fragile vessels in the subacute phase after cerebral ischemia. CONCLUSIONS Our results provide new insights into both BMC-based therapies and immune cell biology and help to understand potential adverse and unexpected side effects.
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Affiliation(s)
- Jan-Kolja Strecker
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.).
| | - Joanna Olk
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Maike Hoppen
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Burkhard Gess
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Kai Diederich
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Antje Schmidt
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Wolf-Rüdiger Schäbitz
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Matthias Schilling
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
| | - Jens Minnerup
- From the Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany (J.-K.S., J.O., M.H., B.G., K.D., A.S., M.S., J.M.); and EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.)
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72
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Yu JH, Seo JH, Lee JY, Lee MY, Cho SR. Induction of Neurorestoration From Endogenous Stem Cells. Cell Transplant 2016; 25:863-82. [PMID: 26787093 DOI: 10.3727/096368916x690511] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Neural stem cells (NSCs) persist in the subventricular zone lining the ventricles of the adult brain. The resident stem/progenitor cells can be stimulated in vivo by neurotrophic factors, hematopoietic growth factors, magnetic stimulation, and/or physical exercise. In both animals and humans, the differentiation and survival of neurons arising from the subventricular zone may also be regulated by the trophic factors. Since stem/progenitor cells present in the adult brain and the production of new neurons occurs at specific sites, there is a possibility for the treatment of incurable neurological diseases. It might be feasible to induce neurogenesis, which would be particularly efficacious in the treatment of striatal neurodegenerative conditions such as Huntington's disease, as well as cerebrovascular diseases such as ischemic stroke and cerebral palsy, conditions that are widely seen in the clinics. Understanding of the molecular control of endogenous NSC activation and progenitor cell mobilization will likely provide many new opportunities as therapeutic strategies. In this review, we focus on endogenous stem/progenitor cell activation that occurs in response to exogenous factors including neurotrophic factors, hematopoietic growth factors, magnetic stimulation, and an enriched environment. Taken together, these findings suggest the possibility that functional brain repair through induced neurorestoration from endogenous stem cells may soon be a clinical reality.
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Affiliation(s)
- Ji Hea Yu
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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73
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Abstract
Over recent decades, experimental and clinical stroke studies have identified a number of neurorestorative treatments that stimulate neural plasticity and promote functional recovery. In contrast to the acute stroke treatments thrombolysis and endovascular thrombectomy, neurorestorative treatments are still effective when initiated days after stroke onset, which makes them applicable to virtually all stroke patients. In this article, selected physical, pharmacological and cell-based neurorestorative therapies are discussed, with special emphasis on interventions that have already been transferred from the laboratory to the clinical setting. We explain molecular and structural processes that promote neural plasticity, discuss potential limitations of neurorestorative treatments, and offer a speculative viewpoint on how neurorestorative treatments will evolve.
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Affiliation(s)
- Antje Schmidt
- a Department of Neurology , University of Münster , Münster , Germany
| | - Jens Minnerup
- a Department of Neurology , University of Münster , Münster , Germany
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74
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Gonzales NR, Grotta JC. Pharmacologic Modification of Acute Cerebral Ischemia. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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75
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76
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Wouters A, Dupont P, Ringelstein EB, Norrving B, Chamorro A, Grond M, Laage R, Schneider A, Wilms G, Thomalla G, Lemmens R, Thijs VN. Association between the perfusion/diffusion and diffusion/FLAIR mismatch: data from the AXIS2 trial. J Cereb Blood Flow Metab 2015; 35:1681-6. [PMID: 26036936 PMCID: PMC4640316 DOI: 10.1038/jcbfm.2015.108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 11/09/2022]
Abstract
The perfusion-/diffusion-weighted imaging (PWI/DWI) mismatch and the diffusion/fluid attenuated inversion recovery (DWI/FLAIR) mismatch are magnetic resonance imaging (MRI) markers of evolving brain ischemia. We examined whether the DWI/FLAIR mismatch was independently associated with the PWI/DWI mismatch. Furthermore, we determined whether the presence of the DWI/FLAIR mismatch in patients with the PWI/DWI mismatch would provide additional information regarding last seen normal time (LTM). We used data from the 'AX200 for ischemic stroke' trial (AXIS 2 study NCT00927836). We studied the association between the presence of the DWI/FLAIR and PWI/DWI mismatch, baseline National Institute of Health Stroke Scale (NIHSS), age, ischemic-core volume, gender, intravenous (IV) tissue plasminogen activator (tPA), and perfusion-mismatch volume in univariate analysis. Significant variables (P<0.05) were added into the final multivariate model. We analyzed 197 patients. Seventy-two (37%) had both the PWI/DWI and the DWI/FLAIR mismatch. Patients with the double mismatch pattern had a shorter LTM than patients with the PWI/DWI mismatch alone (Median difference 90 minutes, P<0.01). Multivariate analysis confirmed the independent association between the two mismatch patterns (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.2 to 5.4). Our study implies that the DWI/FLAIR mismatch and PWI/DWI mismatch are strongly associated, independent from LTM. Furthermore, in the presence of the PWI/DWI mismatch, the DWI/FLAIR pattern indicates a shorter LTM. This could have implications in selecting patients for reperfusion therapy.
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Affiliation(s)
- Anke Wouters
- Department of Neurosciences and Experimental Neurology, KULeuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Division of Experimental Neurology, Department of Neurosciences, KULeuven, Leuven, Belgium.,Medical Imaging Research Center, KULeuven, Leuven, Belgium
| | | | - Bo Norrving
- Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Angel Chamorro
- Stroke Centre, University of Barcelona, Barcelona, Spain
| | - Martin Grond
- Kreisklinikum Siegen GmbH, Klinik für Neurologie, Siegen, Germany
| | - Rico Laage
- GUIDED Development Heidelberg GmbH, Heidelberg, Germany
| | | | - Guido Wilms
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Götz Thomalla
- UKE Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Hamburg, Germany
| | - Robin Lemmens
- Department of Neurosciences and Experimental Neurology, KULeuven, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Vesalius Research Center, KULeuven, Leuven, Belgium
| | - Vincent N Thijs
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Vesalius Research Center, KULeuven, Leuven, Belgium
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Li L, McBride DW, Doycheva D, Dixon BJ, Krafft PR, Zhang JH, Tang J. G-CSF attenuates neuroinflammation and stabilizes the blood-brain barrier via the PI3K/Akt/GSK-3β signaling pathway following neonatal hypoxia-ischemia in rats. Exp Neurol 2015; 272:135-44. [PMID: 25585014 PMCID: PMC4499024 DOI: 10.1016/j.expneurol.2014.12.020] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/22/2014] [Accepted: 12/25/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Neonatal hypoxia occurs in approximately 60% of premature births and is associated with a multitude of neurological disorders. While various treatments have been developed, translating them from bench to bedside has been limited. We previously showed G-CSF administration was neuroprotective in a neonatal hypoxia-ischemia rat pup model, leading us to hypothesize that G-CSF inactivation of GSK-3β via the PI3K/Akt pathway may attenuate neuroinflammation and stabilize the blood-brain barrier (BBB). METHODS P10 Sprague-Dawley rat pups were subjected to unilateral carotid artery ligation followed by hypoxia for 2.5h. We assessed inflammation by measuring expression levels of IKKβ, NF-κB, TNF-α, IL-1β, IL-10, and IL-12 as well as neutrophil infiltration. BBB stabilization was evaluated by measuring Evans blue extravasation, and Western blot analysis of Claudin-3, Claudin-5, ICAM-1, and VCAM-1. MEASUREMENTS AND MAIN RESULTS First, the time course study showed that p-β-catenin/β-catenin, IKKβ, and NF-κB expression levels peaked at 48h post-HI. The knockdown of GSK-3β with siRNA prevented the HI-induced increase of p-β-catenin/β-catenin, IKKβ, and NF-κB expression levels 48h after HI. G-CSF treatment reduced brain water content and neuroinflammation by downregulating IKKβ, NF-κB, TNF-α, IL-1β, and IL-12 and upregulating IL-10, thereby reducing neutrophil infiltration. Additionally, G-CSF stabilizes the BBB by downregulating VCAM-1 and ICAM-1, as well as upregulating Claudins 3 and 5 in endothelial cells. G-CSFR knockdown by siRNA and Akt inhibition by Wortmannin reversed G-CSF's neuroprotective effects. CONCLUSIONS We demonstrate G-CSF plays a pivotal role in attenuating neuroinflammation and BBB disruption following HI by inactivating GSK-3β through the PI3K/Akt pathway.
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Affiliation(s)
- Li Li
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Devin W McBride
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Desislava Doycheva
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Brandon J Dixon
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Paul R Krafft
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - John H Zhang
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA; Department of Anesthesiology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jiping Tang
- Departments of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
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78
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Kleikers PWM, Hooijmans C, Göb E, Langhauser F, Rewell SSJ, Radermacher K, Ritskes-Hoitinga M, Howells DW, Kleinschnitz C, HHW Schmidt H. A combined pre-clinical meta-analysis and randomized confirmatory trial approach to improve data validity for therapeutic target validation. Sci Rep 2015; 5:13428. [PMID: 26310318 PMCID: PMC4550831 DOI: 10.1038/srep13428] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/27/2015] [Indexed: 12/30/2022] Open
Abstract
Biomedical research suffers from a dramatically poor translational success. For example, in ischemic stroke, a condition with a high medical need, over a thousand experimental drug targets were unsuccessful. Here, we adopt methods from clinical research for a late-stage pre-clinical meta-analysis (MA) and randomized confirmatory trial (pRCT) approach. A profound body of literature suggests NOX2 to be a major therapeutic target in stroke. Systematic review and MA of all available NOX2(-/y) studies revealed a positive publication bias and lack of statistical power to detect a relevant reduction in infarct size. A fully powered multi-center pRCT rejects NOX2 as a target to improve neurofunctional outcomes or achieve a translationally relevant infarct size reduction. Thus stringent statistical thresholds, reporting negative data and a MA-pRCT approach can ensure biomedical data validity and overcome risks of bias.
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Affiliation(s)
- Pamela WM. Kleikers
- Department of Pharmacology, CARIM, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Carlijn Hooijmans
- SYRCLE at Central Animal Laboratory, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eva Göb
- Neurologische Klinik und Poliklinik der Universitätsklinik Würzburg, Würzburg, Germany
| | - Friederike Langhauser
- Neurologische Klinik und Poliklinik der Universitätsklinik Würzburg, Würzburg, Germany
| | - Sarah SJ. Rewell
- Florey Institute of Neuroscience and Mental Health, Austin Health, Melbourne, Victoria, Australia
| | - Kim Radermacher
- Department of Pharmacology, CARIM, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Merel Ritskes-Hoitinga
- SYRCLE at Central Animal Laboratory, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - David W. Howells
- Florey Institute of Neuroscience and Mental Health, Austin Health, Melbourne, Victoria, Australia
| | | | - Harald HHW Schmidt
- Department of Pharmacology, CARIM, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
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79
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Taguchi A, Sakai C, Soma T, Kasahara Y, Stern DM, Kajimoto K, Ihara M, Daimon T, Yamahara K, Doi K, Kohara N, Nishimura H, Matsuyama T, Naritomi H, Sakai N, Nagatsuka K. Intravenous Autologous Bone Marrow Mononuclear Cell Transplantation for Stroke: Phase1/2a Clinical Trial in a Homogeneous Group of Stroke Patients. Stem Cells Dev 2015; 24:2207-18. [PMID: 26176265 PMCID: PMC4582686 DOI: 10.1089/scd.2015.0160] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The goal of this clinical trial was to assess the feasibility and safety of transplanting autologous bone marrow mononuclear cells into patients suffering severe embolic stroke. Major inclusion criteria included patients with cerebral embolism, age 20–75 years, National Institute of Health Stroke Scale (NIHSS) score displaying improvement of ≤5 points during the first 7 days after stroke, and NIHSS score of ≥10 on day 7 after stroke. Bone marrow aspiration (25 or 50 mL; N = 6 patients in each case) was performed 7–10 days poststroke, and bone marrow mononuclear cells were administrated intravenously. Mean total transplanted cell numbers were 2.5 × 108 and 3.4 × 108 cells in the lower and higher dose groups, respectively. No apparent adverse effects of administering bone marrow cells were observed. Compared with the lower dose, patients receiving the higher dose of bone marrow cells displayed a trend toward improved neurologic outcomes. Compared with 1 month after treatment, patients receiving cell therapy displayed a trend toward improved cerebral blood flow and metabolic rate of oxygen consumption 6 months after treatment. In comparison with historical controls, patients receiving cell therapy had significantly better neurologic outcomes. Our results indicated that intravenous transplantation of autologous bone marrow mononuclear cells is safe and feasible. Positive results and trends favoring neurologic recovery and improvement in cerebral blood flow and metabolism by cell therapy underscore the relevance of larger scale randomized controlled trials using this approach.
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Affiliation(s)
- Akihiko Taguchi
- 1 Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation , Kobe, Japan .,2 Department of Neurology, National Cerebral and Cardiovascular Center , Suita, Japan
| | - Chiaki Sakai
- 3 Department of Endovascular Therapy, Institute of Biomedical Research and Innovation , Kobe, Japan .,4 Department of Neurosurgery, Kobe City Medical Center General Hospital , Kobe, Japan
| | - Toshihiro Soma
- 5 Department of Hematology, Hyogo College of Medicine , Nishinomiya, Japan
| | - Yukiko Kasahara
- 1 Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation , Kobe, Japan
| | - David M Stern
- 6 Executive Dean's Office, University of Tennessee , Memphis, Tennessee
| | - Katsufumi Kajimoto
- 2 Department of Neurology, National Cerebral and Cardiovascular Center , Suita, Japan
| | - Masafumi Ihara
- 1 Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation , Kobe, Japan .,2 Department of Neurology, National Cerebral and Cardiovascular Center , Suita, Japan
| | - Takashi Daimon
- 7 Department of Biostatistics, Hyogo College of Medicine , Nishinomiya, Japan
| | - Kenichi Yamahara
- 8 Department of Regenerative Medicine, National Cerebral and Cardiovascular Center , Suita, Japan
| | - Kaori Doi
- 9 Department of Nursing, National Cerebral and Cardiovascular Center , Suita, Japan
| | - Nobuo Kohara
- 10 Department of Neurology, Kobe City Medical Center General Hospital , Kobe, Japan
| | - Hiroyuki Nishimura
- 11 Department of Neurology, Nishinomiya Kyoritsu Neurosurgical Hospital , Nishinomiya, Japan
| | - Tomohiro Matsuyama
- 12 Institute for Advanced Medical Sciences, Hyogo College of Medicine , Nishinomiya, Japan
| | - Hiroaki Naritomi
- 2 Department of Neurology, National Cerebral and Cardiovascular Center , Suita, Japan
| | - Nobuyuki Sakai
- 3 Department of Endovascular Therapy, Institute of Biomedical Research and Innovation , Kobe, Japan .,4 Department of Neurosurgery, Kobe City Medical Center General Hospital , Kobe, Japan
| | - Kazuyuki Nagatsuka
- 2 Department of Neurology, National Cerebral and Cardiovascular Center , Suita, Japan
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80
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The Efficacy and Safety of Granulocyte Colony-Stimulating Factor for Patients with Stroke. J Stroke Cerebrovasc Dis 2015; 24:1701-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 11/18/2022] Open
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Abstract
Gene therapy holds exceptional potential for translational medicine by improving the products of defective genes in diseases and/or providing necessary biologics from endogenous sources during recovery processes. However, validating methods for the delivery, distribution and expression of the exogenous genes from such therapy can generally not be applicable to monitor effects over the long term because they are invasive. We report here that human granulocyte colony-stimulating factor (hG-CSF) cDNA encoded in scAAV-type 2 adeno-associated virus, as delivered through eye drops at multiple time points after cerebral ischemia using bilateral carotid occlusion for 60 min (BCAO-60) led to significant reduction in mortality rates, cerebral atrophy, and neurological deficits in C57black6 mice. Most importantly, we validated hG-CSF cDNA expression using translatable magnetic resonance imaging (MRI) in living brains. This noninvasive approach for monitoring exogenous gene expression in the brains has potential for great impact in the area of experimental gene therapy in animal models of heart attack, stroke, Alzheimer’s dementia, Parkinson’s disorder and amyotrophic lateral sclerosis, and the translation of such techniques to emergency medicine.
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82
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Kent TA, Shah SD, Mandava P. Improving early clinical trial phase identification of promising therapeutics. Neurology 2015; 85:274-83. [PMID: 26109712 DOI: 10.1212/wnl.0000000000001757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/23/2015] [Indexed: 11/15/2022] Open
Abstract
This review addresses decision-making underlying the frequent failure to confirm early-phase positive trial results and how to prioritize which early agents to transition to late phase. While unexpected toxicity is sometimes responsible for late-phase failures, lack of efficacy is also frequently found. In stroke as in other conditions, early trials often demonstrate imbalances in factors influencing outcome. Other issues complicate early trial analysis, including unequally distributed noise inherent in outcome measures and variations in natural history among studies. We contend that statistical approaches to correct for imbalances and noise, while likely valid for homogeneous conditions, appear unable to accommodate disease complexity and have failed to correctly identify effective agents. While blinding and randomization are important to reduce selection bias, these methods appear insufficient to insure valid conclusions. We found potential sources of analytical errors in nearly 90% of a sample of early stroke trials. To address these issues, we recommend changes in early-phase analysis and reporting: (1) restrict use of statistical correction to studies where the underlying assumptions are validated, (2) select dichotomous over continuous outcomes for small samples, (3) consider pooled samples to model natural history to detect early therapeutic signals and increase the likelihood of replication in larger samples, (4) report subgroup baseline conditions, (5) consider post hoc methods to restrict analysis to subjects with an appropriate match, and (6) increase the strength of effect threshold given these cumulative sources of noise and potential errors. More attention to these issues should lead to better decision-making regarding selection of agents to proceed to pivotal trials.
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Affiliation(s)
- Thomas A Kent
- From The Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine; and Center of Translational Research on Inflammatory Diseases, Michael E. DeBakey Stroke Program, Michael E. DeBakey VA Medical Center, Houston, TX.
| | - Shreyansh D Shah
- From The Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine; and Center of Translational Research on Inflammatory Diseases, Michael E. DeBakey Stroke Program, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Pitchaiah Mandava
- From The Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine; and Center of Translational Research on Inflammatory Diseases, Michael E. DeBakey Stroke Program, Michael E. DeBakey VA Medical Center, Houston, TX
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Granulocyte-Colony Stimulating Factor Increases Cerebral Blood Flow via a NO Surge Mediated by Akt/eNOS Pathway to Reduce Ischemic Injury. ScientificWorldJournal 2015; 2015:657932. [PMID: 26146654 PMCID: PMC4471400 DOI: 10.1155/2015/657932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 11/17/2022] Open
Abstract
Granulocyte-colony stimulating factor (G-CSF) protects brain from ischemic/reperfusion (I/R) injury, and inhibition of nitric oxide (NO) synthases partially reduces G-CSF protection. We thus further investigated the effects of G-CSF on ischemia-induced NO production and its consequence on regional cerebral blood flow (rCBF) and neurological deficit. Endothelin-1 (ET-1) microinfused above middle cerebral artery caused a rapid reduction of rCBF (ischemia) which lasted for 30 minutes and was followed by a gradual recovery of blood flow (reperfusion) within the striatal region. Regional NO concentration increased rapidly (NO surge) during ischemia and recovered soon to the baseline. G-CSF increased rCBF resulting in shorter ischemic duration and an earlier onset of reperfusion. The enhancement of the ischemia-induced NO by G-CSF accompanied by elevation of phospho-Akt and phospho-eNOS was noted, suggesting an activation of Akt/eNOS. I/R-induced infarct volume and neurological deficits were also reduced by G-CSF treatment. Inhibition of NO synthesis by L-NG-Nitroarginine Methyl Ester (L-NAME) significantly reduced the effects of G-CSF on rCBF, NO surge, infarct volume, and neurological deficits. We conclude that G-CSF increases rCBF through a NO surge mediated by Akt/eNOS, which partially contributes to the beneficial effect of G-CSF on brain I/R injury.
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84
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Kufner A, Wouters A, Bracoud L, Laage R, Schneider A, Schäbitz WR, Hermier M, Thijs V, Fiebach JB. Infarct Volume-Based Subgroup Selection in Acute Ischemic Stroke Trials. Stroke 2015; 46:1368-70. [DOI: 10.1161/strokeaha.114.008115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/20/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We investigated whether hyperintensities with a diameter of at least 3, 3.5, and 4 cm and visible on at least 3 slices on diffusion-weighted imaging enables patient selection with an infarct volume of ≥15 mL.
Methods—
Consecutive acute stroke patients were screened for the AXIS2 trial and examined according to a standardized magnetic resonance imaging protocol in 65 sites. Diffusion-weighted lesion diameters were measured and compared with volumetric assessments.
Results—
Out of 238 patients, 86.2% (N=206) had infarct diameter of at least 3 cm. Volumetric assessments showed infarct volume of ≥15 mL in 157 patients. A cut-off value of 3 cm led to 96.8% sensitivity and 33.3% specificity for predicting lesion volume of ≥15 mL. Analogously, a 3.5 cm cut-off led to 96.8% sensitivity and 50.6% specificity and a 4 cm cut-off led to 91.7% sensitivity and 61.7% specificity.
Conclusions—
Lesion diameter measures may enable multicentric patient recruitment with a prespecified minimal infarct volume.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00927836.
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Affiliation(s)
- Anna Kufner
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Anke Wouters
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Luc Bracoud
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Rico Laage
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Armin Schneider
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Wolf-Rüdiger Schäbitz
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Marc Hermier
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Vincent Thijs
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
| | - Jochen B. Fiebach
- From the Department of Neurology, Center for Stroke Research Berlin, Charité University Hospital Berlin, Germany (A.K., J.B.F.); Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium (A.W., V.T.); Department of Neurology, BioClinica Bio-Imaging Technologies, Lyon France (L.B.); Department of Neurology, Sygnis Bioscience, Im Neuenheimer Feld 515, Heidelberg, Germany (R.L., A.S.); Department of Neurology, Evangelisches Krankenhaus Bielefeld, Germany (W.-R
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85
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Smith CJ, Denes A, Tyrrell PJ, Di Napoli M. Phase II anti-inflammatory and immune-modulating drugs for acute ischaemic stroke. Expert Opin Investig Drugs 2015; 24:623-43. [PMID: 25727670 DOI: 10.1517/13543784.2015.1020110] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Stroke is the second leading cause of death worldwide and the leading cause of adult neurological disability. Despite advances in stroke unit care, and increasing use of thrombolysis, there remains an urgent need for safe and effective treatments for acute ischaemic stroke. However, this is against a backdrop of multiple failures in translational drug development. Cerebral ischaemia initiates a complex cascade of immune and inflammatory pathways in the brain microvasculature and periphery, which contribute to the evolution of cerebral injury, resolution and repair. Targeting specific inflammatory or immune pathways, therefore, represents an attractive treatment strategy in acute ischaemic stroke. Although anti-inflammatory drugs have already failed in clinical trial development, several are currently at the Phase II developmental stage. AREAS COVERED The authors highlight several candidate drugs, which modulate a range of inflammatory and immune pathways, and have been investigated in pre-clinical and Phase II studies to date. EXPERT OPINION Drugs targeting inflammatory and immune pathways offer theoretical advantages including potentially longer therapeutic time windows and effects complementary to thrombolysis (ameliorating reperfusion injury). Fundamental changes in the approach to pre-clinical and clinical drug development are required to facilitate successful translation of promising candidate drugs into clinical practice.
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Affiliation(s)
- Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Department of Medical Neurosciences, Salford Royal Foundation Trust , Salford , UK
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86
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Neuroprotection for ischaemic stroke: Current status and challenges. Pharmacol Ther 2015; 146:23-34. [DOI: 10.1016/j.pharmthera.2014.09.003] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022]
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87
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Detante O, Jaillard A, Moisan A, Barbieux M, Favre I, Garambois K, Barbier E, Hommel M. Fisiopatologia dell’ischemia cerebrale. Neurologia 2015. [DOI: 10.1016/s1634-7072(14)69823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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88
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Benakis C, Garcia-Bonilla L, Iadecola C, Anrather J. The role of microglia and myeloid immune cells in acute cerebral ischemia. Front Cell Neurosci 2015; 8:461. [PMID: 25642168 PMCID: PMC4294142 DOI: 10.3389/fncel.2014.00461] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/18/2014] [Indexed: 01/15/2023] Open
Abstract
The immune response to acute cerebral ischemia is a major contributor to stroke pathobiology. The inflammatory response is characterized by the participation of brain resident cells and peripheral leukocytes. Microglia in the brain and monocytes/neutrophils in the periphery have a prominent role in initiating, sustaining and resolving post-ischemic inflammation. In this review we aim to summarize recent literature concerning the origins, fate and role of microglia, monocytes and neutrophils in models of cerebral ischemia and to discuss their relevance for human stroke.
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Affiliation(s)
- Corinne Benakis
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Lidia Garcia-Bonilla
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College New York, NY, USA
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89
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Beom J, Kim W, Han TR, Seo KS, Oh BM. Concurrent use of granulocyte-colony stimulating factor with repetitive transcranial magnetic stimulation did not enhance recovery of function in the early subacute stroke in rats. Neurol Sci 2014; 36:771-7. [PMID: 25528461 DOI: 10.1007/s10072-014-2046-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/15/2014] [Indexed: 11/28/2022]
Abstract
We investigated the additive effect of repetitive transcranial magnetic stimulation (rTMS) combined with granulocyte-colony stimulating factor (G-CSF) on functional outcome in the early subacute phase of stroke. Seven-week-old male rats were subjected to permanent middle cerebral artery occlusion (MCAo) and were divided into four groups: normal saline administration with sham rTMS (group 1, n = 15), G-CSF administration with sham rTMS (group 2, n = 15), G-CSF with 1 Hz rTMS (group 3, n = 14), and G-CSF with 20 Hz rTMS (group 4, n = 15). Animals received G-CSF or saline for 5 days from the day of MCAo and were concurrently treated with 20-min rTMS on their lesioned hemisphere for 2 weeks. Neurological functional score was worse in group 4 compared to that in group 2 on day 15. In Western blots conducted on day 25, phosphorylation of endothelial nitric oxide synthase was markedly lower in groups 2, 3, and 4 than that in group 1 in the ischemic border zone. PECAM-1 expression at ischemic core was lower in groups 4 than in group 2. Caspase-3 expression was markedly higher in groups 4 than in group 1, 2, 3 at ischemic core. Iba1 expression was higher in groups 4 than in group 1, 2 at ischemic core. G-CSF combined with rTMS administered in the early subacute phase of ischemic stroke may exert a hazardous effect on functional recovery, possibly due to impaired angiogenic mechanism, decreased cell survival, and increased inflammation.
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Affiliation(s)
- Jaewon Beom
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, 301-721, Republic of Korea
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90
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Diederich K, Schmidt A, Beuker C, Strecker JK, Wagner DC, Boltze J, Schäbitz WR, Minnerup J. Granulocyte colony-stimulating factor (G-CSF) treatment in combination with transplantation of bone marrow cells is not superior to G-CSF treatment alone after cortical stroke in spontaneously hypertensive rats. Front Cell Neurosci 2014; 8:411. [PMID: 25538562 PMCID: PMC4255603 DOI: 10.3389/fncel.2014.00411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/12/2014] [Indexed: 12/02/2022] Open
Abstract
Granulocyte-colony stimulating factor (G-CSF) and bone marrow derived mononuclear cells (BM-MNCs) have both been shown to improve functional outcome following experimental stroke. These effects are associated with increased angiogenesis and neurogenesis. In the present study, we aimed to determine synergistic effects of G-CSF and BM-NMC treatment on long-term structural and functional recovery after photothrombotic stroke. To model the etiology of stroke more closely, we used spontaneously hypertensive (SH) rats in our experiment. Bone marrow derived mononuclear cells transplantation was initiated 1 h after the onset of photothrombotic stroke. Repeated G-CSF treatment commenced immediately after BM-MNC treatment followed by daily injections for five consecutive days. The primary endpoint was functional outcome after ischemia. Secondary endpoints included analysis of neurogenesis and angiogenesis as well as determination of infarct size. Granulocyte-colony stimulating factor treated rats, either in combination with BM-MNC or alone showed improved somatosensory but not gross motor function following ischemia. No beneficial effect of BM-MNC monotherapy was found. Infarct volumes were comparable in all groups. In contrast to previous studies, which used healthy animals, post-stroke neurogenesis and angiogenesis were not enhanced by G-CSF. In conclusion, the combination of G-CSF and BM-MNC was not more effective than G-CSF alone. The reduced efficacy of G-CSF treatment and the absence of any beneficial effect of BM-MNC transplantation might be attributed to hypertension-related morbidity.
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Affiliation(s)
- Kai Diederich
- Department of Neurology, University of Münster Münster, Germany
| | - Antje Schmidt
- Department of Neurology, University of Münster Münster, Germany
| | - Carolin Beuker
- Department of Neurology, University of Münster Münster, Germany
| | | | - Daniel-Christoph Wagner
- Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Germany ; Translational Center for Regenerative Medicine, University of Leipzig Leipzig, Germany
| | - Johannes Boltze
- Fraunhofer Institute for Cell Therapy and Immunology Leipzig, Germany ; Translational Center for Regenerative Medicine, University of Leipzig Leipzig, Germany
| | | | - Jens Minnerup
- Department of Neurology, University of Münster Münster, Germany
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91
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Raval AN, Schmuck EG, Tefera G, Leitzke C, Ark CV, Hei D, Centanni JM, de Silva R, Koch J, Chappell RG, Hematti P. Bilateral administration of autologous CD133+ cells in ambulatory patients with refractory critical limb ischemia: lessons learned from a pilot randomized, double-blind, placebo-controlled trial. Cytotherapy 2014; 16:1720-32. [PMID: 25239491 PMCID: PMC4253573 DOI: 10.1016/j.jcyt.2014.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND AIMS CD133+ cells confer angiogenic potential and may be beneficial for the treatment of critical limb ischemia (CLI). However, patient selection, blinding methods and end points for clinical trials are challenging. We hypothesized that bilateral intramuscular administration of cytokine-mobilized CD133+ cells in ambulatory patients with refractory CLI would be feasible and safe. METHODS In this double-blind, randomized sham-controlled trial, subjects received subcutaneous injections of granulocyte colony-stimulating factor (10 μg/kg per day) for 5 days, followed by leukapheresis, and intramuscular administration of 50-400 million sorted CD133+ cells delivered into both legs. Control subjects received normal saline injections, sham leukapheresis and intramuscular injection of placebo buffered solution. Subjects were followed for 1 year. An aliquot of CD133+ cells was collected from each subject to test for genes associated with cell senescence. RESULTS Seventy subjects were screened, of whom 10 were eligible. Subject enrollment was suspended because of a high rate of mobilization failure in subjects randomly assigned to treatment. Of 10 subjects enrolled (7 randomly assigned to treatment, 3 randomly assigned to control), there were no differences in serious adverse events at 12 months, and blinding was preserved. There were non-significant trends toward improved amputation-free survival, 6-minute walk distance, walking impairment questionnaire and quality of life in subjects randomly assigned to treatment. Successful CD133+ mobilizers expressed fewer senescence-associated genes compared with poor mobilizers. CONCLUSIONS Bilateral administration of autologous CD133+ cells in ambulatory CLI subjects was safe, and blinding was preserved. However, poor mobilization efficiency combined with high CD133+ senescence suggests futility in this approach.
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Affiliation(s)
- Amish N Raval
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Eric G Schmuck
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Girma Tefera
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cathlyn Leitzke
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cassondra Vander Ark
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Derek Hei
- Waisman Biomanufacturing Facility, Madison, Wisconsin, USA
| | - John M Centanni
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jill Koch
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Richard G Chappell
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peiman Hematti
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Detante O, Jaillard A, Moisan A, Barbieux M, Favre I, Garambois K, Hommel M, Remy C. Biotherapies in stroke. Rev Neurol (Paris) 2014; 170:779-98. [DOI: 10.1016/j.neurol.2014.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/29/2014] [Accepted: 10/08/2014] [Indexed: 12/31/2022]
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93
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Minnerup J, Trinczek B, Storck M, Hohenberger M, Wilpsbäumer S, Abdul-Rahim AH, Liesirova KT, Broeg-Morvay A, Meisterernst J, Lees KR, Mattle HP, Wersching H, Dziewas R, Schäbitz WR, Schilling M. Feasibility platform for stroke studies: an online tool to improve eligibility criteria for clinical trials. Stroke 2014; 46:137-42. [PMID: 25395412 DOI: 10.1161/strokeaha.114.007124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Eligibility criteria are a key factor for the feasibility and validity of clinical trials. We aimed to develop an online tool to assess the potential effect of inclusion and exclusion criteria on the proportion of patients eligible for an acute stroke trial. METHODS We identified relevant inclusion and exclusion criteria of acute stroke trials. Based on these criteria and using a cohort of 1537 consecutive patients with acute ischemic stroke from 3 stroke centers, we developed a web portal feasibility platform for stroke studies (FePASS) to estimate proportions of eligible patients for acute stroke trials. We applied the FePASS resource to calculate the proportion of patients eligible for 4 recent stroke studies. RESULTS Sixty-one eligibility criteria were derived from 30 trials on acute ischemic stroke. FePASS, publicly available at http://fepass.uni-muenster.de, displays the proportion of patients in percent to assess the effect of varying values of relevant eligibility criteria, for example, age, symptom onset time, National Institutes of Health Stroke Scale, and prestroke modified Rankin Scale, on this proportion. The proportion of eligible patients for 4 recent stroke studies ranged from 2.1% to 11.3%. Slight variations of the inclusion criteria could substantially increase the proportion of eligible patients. CONCLUSIONS FePASS is an open access online resource to assess the effect of inclusion and exclusion criteria on the proportion of eligible patients for a stroke trial. FePASS can help to design stroke studies, optimize eligibility criteria, and to estimate the potential recruitment rate.
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Affiliation(s)
- Jens Minnerup
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.).
| | - Benjamin Trinczek
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Michael Storck
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Maria Hohenberger
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Simon Wilpsbäumer
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Azmil H Abdul-Rahim
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Kai Timo Liesirova
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Anne Broeg-Morvay
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Julia Meisterernst
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Kennedy R Lees
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Heinrich P Mattle
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Heike Wersching
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Rainer Dziewas
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Wolf-Rüdiger Schäbitz
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
| | - Matthias Schilling
- From the Department of Neurology (J. Minnerup, M.H., R.D., M. Schilling), Institute of Medical Informatics (B.T., M. Storck, S.W.), Institute of Epidemiology and Social Medicine (H.W.), University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.H.A.-R., K.R.L.); Department of Neurology, Inselspital, University of Bern, Bern, Switzerland (K.T.L., A.B.-M., J. Meisterernst, H.P.M.); and Department of Neurology, Bethel, Bielefeld, Germany (W.-R.S.)
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Urfer R, Moebius HJ, Skoloudik D, Santamarina E, Sato W, Mita S, Muir KW. Phase II trial of the Sigma-1 receptor agonist cutamesine (SA4503) for recovery enhancement after acute ischemic stroke. Stroke 2014; 45:3304-10. [PMID: 25270629 DOI: 10.1161/strokeaha.114.005835] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The σ-1 receptor (Sig-1R) agonist cutamesine (SA4503) enhanced functional recovery after experimental stroke with a treatment initiation window of 48 hours and chronic treatment for 28 days. We conducted a phase 2 clinical trial exploring the safety, tolerability, dose range, and functional effects of cutamesine in patients with ischemic stroke. METHODS Subjects were randomized between 48 and 72 hours after stroke to receive cutamesine 1 mg/d, 3 mg/d, or placebo for 28 days. Effects on safety and function were assessed at baseline, at end of treatment (day 28), and at end of follow-up (day 56). RESULTS In 60 patients, treatment with both cutamesine dosages was safe and well tolerated without significant differences in numbers of treatment emergent or serious adverse events. No significant effect was observed on the primary efficacy measure (change in National Institutes of Health Stroke Scale from baseline to day 56) or modified Rankin Scale and Barthel Index scores. Post hoc analysis of moderately and severely affected patients (baseline National Institutes of Health Stroke Scale, ≥7 and ≥10) showed greater National Institutes of Health Stroke Scale improvements in the 3 mg/d cutamesine group when compared with placebo (P=0.034 and P=0.038, respectively). A trend toward a higher proportion being able to complete a 10m timed walk was observed for cutamesine-treated subjects. CONCLUSIONS Cutamesine was safe and well tolerated at both dosage levels. Although no significant effects on functional end points were seen in the population as a whole, greater improvement in National Institutes of Health Stroke Scale scores among patients with greater pretreatment deficits seen in post hoc analysis warrants further investigation. Additional studies should focus on the patient population with moderate-to-severe stroke. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov/show/NCT00639249. Unique identifier: NCT00639249. The EudraCT number is 2007-004840-60 (https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-004840-60/GB).
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Affiliation(s)
- Roman Urfer
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Hans J Moebius
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.)
| | - David Skoloudik
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Estevo Santamarina
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Wakao Sato
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Shiro Mita
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.)
| | - Keith W Muir
- From the M's Science Corporation, Kobe, Japan (R.U., W.S., S.M.); Moebius-Consult GmbH, Zurich, Switzerland (H.J.M.); Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic (D.S.); Neurovascular Unit, Hospital Vall Hebron, Barcelona, Spain (E.S.); and Institute of Neuroscience and Psychology, University of Glasgow, Southern General Hospital, Glasgow, Scotland, United Kingdom (K.W.M.).
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95
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Moniche F, Montaner J, Gonzalez-Marcos JR, Carmona M, Piñero P, Espigado I, Cayuela A, Escudero I, de la Torre-Laviana FJ, Boada C, Rosell A, Mayol A, Jimenez MD, Gil-Peralta A, Gonzalez A. Intra-arterial bone marrow mononuclear cell transplantation correlates with GM-CSF, PDGF-BB, and MMP-2 serum levels in stroke patients: results from a clinical trial. Cell Transplant 2014; 23 Suppl 1:S57-64. [PMID: 25335778 DOI: 10.3727/096368914x684934] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bone marrow mononuclear cell (BM-MNC) intra-arterial transplantation improves recovery in experimental models of ischemic stroke through secretion of cytokines and growth factors (GFs), enhancing neoangiogenesis, and enhancing neuroplasticity. In this study, we tested whether BM-MNC transplantation in stroke patients induces changes in serum levels of cytokines and GFs. A phase I/II trial was conducted in middle cerebral artery (MCA) stroke patients with autologous intra-arterial BM-MNC transplantation between 5 and 9 days after stroke. Follow-up was done for up to 6 months. Eight cases and nine controls were included, and the serum levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), platelet-derived growth factor-BB (PDGF-BB), β nerve growth factor (β-NGF), and matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) were measured before and 4, 8, and 90 days after transplantation. The correlation of these serum levels with dose of cells and clinical outcomes was studied. A total of 1.59 × 10(8) (±1.21 × 10(8)) BM-MNCs were injected in cases; of them 3.38 × 10(6) (±2.33 × 10(6)) were CD34(+) cells. There was a positive correlation between total BM-MNCs injected and levels of GM-CSF and PDGF-BB at 90 days after transplantation (r = 0.929, p = 0.001 and r = 0.714, p = 0.047, respectively), and a negative correlation between total CD34(+) cells injected and MMP-2 levels at 4 days after transplantation (r = -0.786, p = 0.036). Lower plasma levels of MMP-2 at 4 days and higher levels of PDGF-BB at 90 days were associated with better functional outcomes during follow-up (p = 0.019 and p = 0.037, respectively). When administered intra-arterially in subacute MCA stroke patients, BM-MNCs seem to induce changes in serum levels of GM-CSF, PDGF-BB, and MMP-2, even 3 months after transplantation, which could be associated with better functional outcomes. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.
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Affiliation(s)
- Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
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96
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The temporo-spatial localization of polymorphonuclear cells related to the neurovascular unit after transient focal cerebral ischemia. Brain Res 2014; 1586:184-92. [DOI: 10.1016/j.brainres.2014.08.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/06/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
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Pösel C, Scheibe J, Kranz A, Bothe V, Quente E, Fröhlich W, Lange F, Schäbitz WR, Minnerup J, Boltze J, Wagner DC. Bone marrow cell transplantation time-dependently abolishes efficacy of granulocyte colony-stimulating factor after stroke in hypertensive rats. Stroke 2014; 45:2431-7. [PMID: 24984745 DOI: 10.1161/strokeaha.113.004460] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to determine a possible synergistic effect of granulocyte colony-stimulating factor (G-CSF) and bone marrow-derived mononuclear cells (BM MNC) after stroke in spontaneously hypertensive rats. METHODS Male spontaneously hypertensive rats were subjected to middle cerebral artery occlusion and randomly assigned to daily injection of 50 μg/kg G-CSF for 5 days starting 1 hour after stroke (groups 1, 2, and 3) with additional intravenous transplantation of 1.5×10E7 BM MNC per kilogram at 6 hours (group 2) or 48 hours (group 3) after stroke, or control treatment (group 4). Circulating leukocyte counts and functional deficits, infarct volume, and brain edema were repeatedly assessed in the first week and first month. RESULTS G-CSF treatment led to a significant neutrophilia, to a reversal of postischemic depression of circulating leukocytes, and to a significantly improved functional recovery without affecting the infarct volume or brain edema. BM MNC cotransplantation was neutral after 6 hours, but reversed the functional effect of G-CSF after 48 hours. Short-term investigation of combined G-CSF and BM MNC treatment at 48 hours indicated splenic accumulation of granulocytes and transplanted cells, accompanied by a significant rise of granulocytes in the circulation and the ischemic brain. CONCLUSIONS G-CSF improved functional recovery in spontaneously hypertensive rats, but this effect was abolished by cotransplantation of BM MNC after 48 hours. In the spleen, transplanted cells may hinder the clearance of granulocytes that were massively increased by G-CSF. Increased circulation and infiltration of granulocytes into the ischemic brain may be detrimental for stroke outcome.
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Affiliation(s)
- Claudia Pösel
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.).
| | - Johanna Scheibe
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Alexander Kranz
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Viktoria Bothe
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Elfi Quente
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Wenke Fröhlich
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Franziska Lange
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Wolf-Rüdiger Schäbitz
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Jens Minnerup
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Johannes Boltze
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
| | - Daniel-Christoph Wagner
- From the Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (C.P., J.S., A.K., E.Q., W.F., F.L., J.B., D.-C.W.); Translational Centre for Regenerative Medicine, Leipzig, Germany (A.K., V.B., E.Q., W.F., J.B., D.-C.W.); EVK Bielefeld, Bethel, Neurologische Klinik, Bielefeld, Germany (W.-R.S.); Department of Neurology, University of Münster, Germany (J.M.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.B.)
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98
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Balseanu AT, Buga AM, Catalin B, Wagner DC, Boltze J, Zagrean AM, Reymann K, Schaebitz W, Popa-Wagner A. Multimodal Approaches for Regenerative Stroke Therapies: Combination of Granulocyte Colony-Stimulating Factor with Bone Marrow Mesenchymal Stem Cells is Not Superior to G-CSF Alone. Front Aging Neurosci 2014; 6:130. [PMID: 25002846 PMCID: PMC4066299 DOI: 10.3389/fnagi.2014.00130] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/03/2014] [Indexed: 01/01/2023] Open
Abstract
Attractive therapeutic strategies to enhance post-stroke recovery of aged brains include methods of cellular therapy that can enhance the endogenous restorative mechanisms of the injured brain. Since stroke afflicts mostly the elderly, it is highly desirable to test the efficacy of cell therapy in the microenvironment of aged brains that is generally refractory to regeneration. In particular, stem cells from the bone marrow allow an autologous transplantation approach that can be translated in the near future to the clinical practice. Such a bone marrow-derived therapy includes the grafting of stem cells as well as the delayed induction of endogenous stem cell mobilization and homing by the stem cell mobilizer granulocyte colony-stimulating factor (G-CSF). We tested the hypothesis that grafting of bone marrow-derived pre-differentiated mesenchymal cells (BM-MSCs) in G-CSF-treated animals improves the long-term functional outcome in aged rodents. To this end, G-CSF alone (50 μg/kg) or in combination with a single dose (106 cells) of rat BM MSCs was administered intravenously to Sprague-Dawley rats at 6 h after transient occlusion (90 min) of the middle cerebral artery. Infarct volume was measured by magnetic resonance imaging at 3 and 48 days post-stroke and additionally by immunhistochemistry at day 56. Functional recovery was tested during the entire post-stroke survival period of 56 days. Daily treatment for post-stroke aged rats with G-CSF led to a robust and consistent improvement of neurological function after 28 days. The combination therapy also led to robust angiogenesis in the formerly infarct core and beyond in the “islet of regeneration.” However, G-CSF + BM MSCs may not impact at all on the spatial reference-memory task or infarct volume and therefore did not further improve the post-stroke recovery. We suggest that in a real clinical practice involving older post-stroke patients, successful regenerative therapies would have to be carried out for a much longer time.
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Affiliation(s)
- Adrian Tudor Balseanu
- Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova , Craiova , Romania
| | - Ana-Maria Buga
- Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova , Craiova , Romania ; Department of Psychiatry, University Medicine of Rostock , Rostock , Germany
| | - Bogdan Catalin
- Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova , Craiova , Romania
| | | | - Johannes Boltze
- Fraunhofer Institute for Cell Therapy and Immunology , Leipzig , Germany ; Translational Center for Regenerative Medicine, University of Leipzig , Leipzig , Germany ; Stroke and Neurovascular Regulation Laboratory, Massachusetts General Hospital and Harvard Medical School , Charlestown, MA , USA
| | - Ana-Maria Zagrean
- Carol Davila University of Medicine and Pharmacy , Bucharest , Romania
| | - Klaus Reymann
- German Center for Neurodegenerative Diseases (DZNE) Magdeburg in collobaration with Leibniz Institute for Neurobiology , Magdeburg , Germany
| | - Wolf Schaebitz
- Evangelisches Krankenhaus Bielefeld gGmbH Akademisches Lehrkrankenhaus der Universität Münster , Münster , Germany
| | - Aurel Popa-Wagner
- Center of Clinical and Experimental Medicine, University of Medicine and Pharmacy of Craiova , Craiova , Romania ; Department of Psychiatry, University Medicine of Rostock , Rostock , Germany
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99
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Dirnagl U, Endres M. Found in translation: preclinical stroke research predicts human pathophysiology, clinical phenotypes, and therapeutic outcomes. Stroke 2014; 45:1510-8. [PMID: 24652307 DOI: 10.1161/strokeaha.113.004075] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ulrich Dirnagl
- From the Departments of Neurology and Experimental Neurology, Center for Stroke Research Berlin, and Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany (U.D., M.E.); German Center for Neurodegeneration Research (DZNE), Partner Site, Berlin, Germany (U.D.); and German Center for Cardiovascular Diseases (DZHK), Partner Site, Berlin, Germany (U.D., M.E.)
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100
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Sugiyama Y, Yagita Y, Yukami T, Watanabe A, Oyama N, Terasaki Y, Omura-Matsuoka E, Sasaki T, Mochizuki H, Kitagawa K. Granulocyte colony-stimulating factor fails to enhance leptomeningeal collateral growth in spontaneously hypertensive rats. Neurosci Lett 2014; 564:16-20. [PMID: 24508053 DOI: 10.1016/j.neulet.2014.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/08/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
The promotion of collateral artery growth is an attractive approach for the treatment of chronic brain hypoperfusion due to occlusive artery disease. We previously reported that hypertension impaired the collateral artery growth of leptomeningeal anastomoses after brain hypoperfusion. Granulocyte colony-stimulating factor (G-CSF) enhances arteriogenesis in a mouse model via a mechanism involving monocyte/macrophage mobilization. However, the arteriogenic effect of G-CSF in hypertension remains unknown. In the present study, we tested whether G-CSF affected collateral artery growth in both normotensive and hypertensive model rat. Left common carotid artery (CCA) occlusion was performed to induce hypoperfusion in the brains of Wistar rats and spontaneously hypertensive rats (SHR). G-CSF was administered subcutaneously for 5 consecutive days. The superficial angioarchitecture of the leptomeningeal anastomoses and the circle of Willis after CCA occlusion and G-CSF treatment were visualized by latex perfusion. Circulating blood monocytes and CD68-positive cells, which represented the macrophages on the dorsal surface of the brain, were counted. G-CSF enhanced leptomeningeal collateral growth in Wistar rats, but not in SHR. G-CSF increased circulating blood monocytes in both Wistar rats and SHR. The number of CD68-positive cells on the dorsal surface of the brain was increased by G-CSF in Wistar rats, but not in SHR. The increase in macrophage accumulation correlated with the observed arteriogenic effects. In conclusion, G-CSF promotes collateral artery growth in the normotensive model rat, but not in the hypertensive model rat.
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Affiliation(s)
- Yukio Sugiyama
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Yagita
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Toshiro Yukami
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Watanabe
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Oyama
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasukazu Terasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Emi Omura-Matsuoka
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsutomu Sasaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
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