Human urinary kallindinogenase therapy for acute ischemic stroke according to Chinese ischemic stroke subclassification: Clinical efficacy and risk factors

Recent Advances and Therapeutic Implications of 2-Oxoglutarate-Dependent Dioxygenases in Ischemic Stroke

Ischemic stroke is a common disease with a high disability rate and mortality, which brings heavy pressure on families and medical insurance. Nowadays, the golden treatments for ischemic stroke in the acute phase mainly include endovascular therapy and intravenous thrombolysis. Some drugs are used to alleviate brain injury in patients with ischemic stroke, such as edaravone and 3-n-butylphthalide. However, no effective neuroprotective drug for ischemic stroke has been acknowledged. 2-Oxoglutarate-dependent dioxygenases (2OGDDs) are conserved and common dioxygenases whose activities depend on O2, Fe2+, and 2OG. Most 2OGDDs are expressed in the brain and are essential for the development and functions of the brain. Therefore, 2OGDDs likely play essential roles in ischemic brain injury. In this review, we briefly elucidate the functions of most 2OGDDs, particularly the effects of regulations of 2OGDDs on various cells in different phases after ischemic stroke. It would also provide promising potential therapeutic targets and directions of drug development for protecting the brain against ischemic injury and improving outcomes of ischemic stroke.

Protective effects of human urinary kallidinogenase against corticospinal tract damage in acute ischemic stroke patients

This study aimed to assess the effects of human urinary kallidinogenase (HUK) on motor function outcome and corticospinal tract recovery in patients with acute ischemic stroke (AIS). This study was a randomized, controlled, single-blinded trial. Eighty AIS patients were split into two groups: the HUK and control groups. The HUK group was administered HUK and standard treatment, while the control group received standard treatment only. At admission and discharge, the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and muscle strength were scored. The primary endpoint was the short-term outcomes of AIS patients under different treatments. The secondary endpoint was the degree of corticospinal tract fiber damage under different treatments. There was a significant improvement in the NIHSS Scale, BI and muscle strength scores in the HUK group compared with controls (Mann-Whitney U test; P  < 0.05). Diffusion tensor tractography classification and intracranial arterial stenosis were independent predictors of short-term recovery by linear regression analysis. The changes in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) decline rate were significantly smaller in the HUK group than in the control group ( P <  0.05). Vascular endothelial growth factor (VEGF) increased significantly after HUK treatment ( P  < 0.05), and the VEGF change was negatively correlated with changes in ADC. HUK is beneficial for the outcome in AIS patients especially in motor function recovery. It may have protective effects on the corticospinal tract which is reflected by the reduction in the FA and ADC decline rates and increased VEGF expression. The study was registered on ClinicalTrials.gov (unique identifier: NCT04102956).

Efficacy and Safety of Human Urinary Kallidinogenase for Acute Ischemic Stroke: A Retrospective Single-Center Study

BACKGROUND

The aim of this study was to investigate the outcomes of human urinary kallidinogenase (HUK) after recombinant tissue-type plasminogen activator treatment in patients with acute ischemic stroke (AIS).

METHODS

In this retrospective study conducted from December 2018 to August 2020, 313 patients with AIS patients who received recombinant tissue-type plasminogen activator treatment were enrolled. Among them, 148 patients received basic therapy, and 165 patients received HUK treatment. Demographics and clinical characteristics were analyzed after treatment, and patients were monitored for stroke recurrence for 12 months. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were used to assess the efficacy of treatment. Logistic regression analysis was used to identify risk factors for recurrence.

RESULTS

There were no differences in baseline clinical characteristics between the 2 groups in the database. After 14 days of treatment, the HUK group had significantly lower NIHSS and modified Rankin Scale scores than the control group ( P <0.01). The recurrence rates in the HUK and control groups were 12.84% and 21.82%, respectively, with patients treated with HUK having better outcomes ( P <0.001). Logistic analysis indicated that high homocysteine levels and high NIHSS scores at diagnosis were risk factors for AIS recurrence. In addition, HUK treatment was found to reduce the risk of recurrence.

CONCLUSION

Treatment with HUK after intravenous thrombolysis can significantly improve the neurological function of AIS patients and reduce stroke recurrence.

Dazhu Hongjingtian Injection for Ischemic Stroke: Protocol for a Prospective, Multicenter Observational Study

BACKGROUND

Although results from in vitro studies and small randomized controlled trials have shown positive effects of Dazhu hongjingtian injection (DZHJTI) on acute ischemic stroke (AIS), their generalizability to routine clinical practice remains to be established.

OBJECTIVE

The primary aim of this study is to evaluate the effectiveness of DZHJTI treatment for AIS with regard to changes in the stroke-related neurological deficit from baseline to outpatient follow-up, mortality, subsequent vascular events, disability, and traditional Chinese medicine syndrome in real-world clinical settings. By monitoring for adverse events or significant changes in vital signs and laboratory parameters, we also aim to assess the safety of DZHJTI.

METHODS

This prospective, multicenter cohort study plans to enroll 2000 patients with AIS within 14 days of symptom onset from 30 hospitals across China. Eligible patients will be followed up for 6 months after initiating medication treatments. The primary outcome will be the change in the National Institute of Health Stroke Scale score from baseline to outpatient follow-up. The secondary outcomes include overall mortality, stroke recurrence, new-onset major vascular events, global disability, and improvement of traditional Chinese medicine syndrome in 6 months. Adverse events or clinically significant changes in vital signs and laboratory parameters, regardless of the severity, will be recorded during the trial to assess the safety of DZHJTI. An augmented inverse propensity weighted estimator will be used to reduce variability and improve accuracy in average treatment effects estimation.

RESULTS

The clinical trial registration was approved in October 2022, and the recruitment and enrollment of participants started in November 2022. The study's outcomes are expected to be published in 2025 in reputable, peer-reviewed health-related research journals.

CONCLUSIONS

This real-world cohort study is the first to assess the effectiveness and safety of DZHJTI in treating AIS. It may provide additional clinical evidence, including the duration of response, long-term drug effectiveness, and subgroup efficacy data. The study results will be valuable for clinicians and patients seeking optimal treatment for AIS and could lead to better use of DZHJTI and improved patient outcomes.

TRIAL REGISTRATION

ITMCTR ITMCTR2022000005; http://tinyurl.com/554ns8m5.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52447.

Effectiveness of Multidisciplinary Nursing Based on Fever, Blood Sugar, and Swallowing Function Management in Patients with Acute Stroke

Purpose

The aim of this study was to assess the effectiveness of multidisciplinary nursing based on fever, blood sugar, and swallowing function management in patients with acute stroke (AS).

Methods

A total of 200 AS patients who were treated in our hospital from January 2016 to January 2020 were recruited and randomized at a ratio of 1 : 1 into a control group and a study group. The control group received standardized early rehabilitation nursing, and the study group received multidisciplinary nursing based on fever, blood sugar, and swallowing function management plus standardized early rehabilitation nursing. The patients were also assigned different blood glucose levels upon admission to a high blood glucose group or a normal blood glucose group. The clinical endpoint is clinical efficacy.

Results

Multidisciplinary nursing resulted in better clinical outcomes and treatment efficiency in the patients in the study group versus standardized early rehabilitation nursing. When compared with the control group, the patients in the study group showed lower National Institute of Health Stroke Scale (NIHSS) scores, higher Barthel Index (BI) scores, lower fasting blood glucose levels and body temperature 24 hours after admission, a lower incidence of swallowing dysfunction and aspiration pneumonia 30 days after nursing, and lower C-reactive Protein (CRP) levels 7 days after nursing. The NIHSS scores of the high blood glucose group were significantly higher than those of the normal blood glucose group.

Conclusion

Multidisciplinary nursing based on fever, blood sugar, and swallowing function management for patients with AS improves the clinical outcome and treatment efficiency, restores the swallowing function and blood glucose level, and ameliorates the long-term prognosis of patients.

Clinical efficacy and safety of urinary kallindinogenase combined with butylphthalide in the treatment of progressive cerebral infarction

OBJECTIVE

To determine the clinical efficacy and safety of urinary Kallindinogenase (HUK) combined with butylphthalide (NBP) in the treatment of progressive cerebral infarction (PCI), to provide more choices for the clinical treatment of PCI.

METHODS

The clinical data of 94 with PCI admitted to our hospital from July 2015 to March 2017 were retrospectively analyzed in this study. In addition to basic treatment, the control group (n = 52) was treated with NBP and edaravone. The research group (n = 42) was treated with NBP and HUK. After 14 days of treatment, the clinical efficacy on the two groups was evaluated according to their neurological function deficit using the National Institutes of Health Stroke Scale (NIHSS). The functional recovery results after the stroke were measured using the Modified Rankin Scale (MRS). The independence rate of the two groups was compared. The activities of daily living (ADL) scale was adopted to evaluate the patients' life quality. The two groups were compared in the incidence of complications during treatment and the recurrence within 12 months.

RESULTS

The two groups of patients were not greatly different in basic data. After 14 days of treatment, the improvements in NIHSS, MRS, and ADL scores in the research group were more obvious than those in the control group. After 12 months of treatment, the research group showed a significantly higher independence rate than the control group. No serious adverse reactions were found in the two groups. There was no death during the treatment. After 12 months of treatment, the two groups were not greatly different in recurrence rate.

CONCLUSION

HUK combined with NBP can reduce the neurological dysfunction and disability rate of patients and improve their independence rate and life quality. It is a safe and effective method for the treatment of PCI.

Association between serum lipoprotein levels and neurological function in patients with acute ischemic stroke: A protocol of systematic review and meta-analysis

BACKGROUND

The target of this study is to summarize the association between the serum lipoprotein levels and neurological function in patients with acute ischemic stroke.

METHODS

A comprehensive search of Cochrane Library, PUBMED, EMBASE, Web of Science, and Chinese Biomedical Literature Database, China National Knowledge Infrastructure from inception to the February 29, 2020 without language and publication date restrictions. All searched studies will be selected by 2 authors independently against the eligibility criteria. Included studies will be critically appraised, and essential data will be extracted by 2 independent authors. If necessary, meta-analysis will be utilized to synthesize the outcome data from included articles. If it is not possible, a narrative synthesis will be undertaken.

RESULTS

This study will summarize the up-to-date evidence to investigate the association between serum lipoprotein levels and neurological function in patients with acute ischemic stroke.

CONCLUSION

Its results may present beneficial evidence and guidance for the clinical practice and further studies.

STUDY REGISTRATION NUMBER

INPLASY202040043.

Human urinary kallindinogenase therapy for acute ischemic stroke according to Chinese ischemic stroke subclassification: Clinical efficacy and risk factors

INTRODUCTION

To evaluate effectiveness of human urinary kallindinogenase (HUK) in patients with acute ischemic stroke (AIS) according to Chinese ischemic stroke subclassification (CISS) and analyzed risk factors of clinical efficacy.

METHODS

In this retrospective study, 134 patients received conventional therapy were enrolled to control group, and 132 patients received HUK treatment were enrolled to HUK group. National Institute of Health Stroke Scale (NIHSS) score was used to evaluate the clinical efficacy. Multivariate analysis of risk factors was performed by using logistic regression.

RESULTS

After treatment, NIHSS score of HUK group was significant lower than that of control group (p = .009). Effectiveness rate was 71.2% in HUK group, and 53.7% in control group, respectively (p = .003). The NIHSS of patients with large artery atherosclerosis (LAA) subtype in HUK group was significantly lower than that in control group (p = .005). The absence of HUK (OR = 2.75), homocysteine (OR = 0.15), and CS subtype (OR = 0.18) were risk factors for HUK clinical efficacy.

CONCLUSIONS

Human urinary kallindinogenase is an effective therapeutic approach for treatment of patients with AIS, especially in patients with LAA subtype. The absence of HUK, elevated homocysteine, and cardiogenic stroke subtype were risk factor for clinical efficacy of HUK.