Human urinary kallidinogenase combined with edaravone in treating acute ischemic stroke patients: A meta-analysis

Calycosin‑7‑O‑β‑D‑glucoside downregulates mitophagy by mitigating mitochondrial fission to protect HT22 cells from oxygen‑glucose deprivation/reperfusion‑induced injury

Calycosin‑7‑O‑β‑D‑glucoside (CG), a major active ingredient of Astragali Radix, exerts neuroprotective effects against cerebral ischemia; however, whether the effects of CG are associated with mitochondrial protection remains unclear. The present study explored the role of CG in improving mitochondrial function in a HT22 cell model of oxygen‑glucose deprivation/reperfusion (OGD/R). The Cell Counting Kit‑8 assay, flow cytometry, immunofluorescence and western blotting were performed to investigate the effects of CG on mitochondrial function. The results demonstrated that mitochondrial function was restored after treatment with CG, as indicated by reduced mitochondrial reactive oxygen species levels, increased mitochondrial membrane potential and improved mitochondrial morphology. Overactivated mitophagy was revealed to be inhibited by the regulation of proteins involved in fission [phosphorylated‑dynamin‑related protein 1 (Drp1) and Drp1] and mitophagy (LC3, p62 and translocase of outer mitochondrial membrane 20), and mitochondrial biogenesis was demonstrated to be enhanced by increased levels of sirtuin 1 (SIRT1) and peroxisome proliferator‑activated receptor γ coactivator‑1α (PGC‑1α). In addition, neuronal apoptosis was ameliorated by CG, as determined by a decreased rate of apoptosis, and levels of caspase‑3 and Bcl‑2/Bax. In conclusion, the present study demonstrated that CG may alleviate OGD/R‑induced injury by upregulating SIRT1 and PGC‑1α protein expression, and reducing excessive mitochondrial fission and overactivation of mitophagy.

Safety and Efficacy of Neuroprotective Agents as Adjunctive Therapies for Reperfusion in the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

There is still no clear evidence of the efficacy of the application of neuroprotective agents (NPAs) for acute ischemic stroke (AIS) patients receiving reperfusion therapies. This meta-analysis aimed to determine the effects of NPAs versus placebo on functional and safety outcomes as an adjunctive treatment to intravenous thrombolysis (IVT) or endovascular therapy (EVT) in AIS patients. The primary outcome was neurological functional independence, as evaluated by the proportion of patients whose modified Rankin Scale scores were 0 to 2 at 90 days after treatment. Thirteen randomized controlled trials with a total of 3736 patients were included. The application of NPAs was associated with greater odds of functional independence (odds ratio [OR]: 1.28; 95% CI: 1.12 to 1.46; P < 0.001; I2 = 0.0%) within 90 days. However, subgroup analysis of reperfusion therapy type (IVT, EVT, or both) revealed that only the EVT subgroup showed a significant association between NPAs or placebo and functional independence at 90 days (EVT group, OR: 1.43; 95% CI: 1.05 to 1.94; P = 0.022; I2 = 0.0%; IVT group, OR: 1.51; 95% CI: 0.93 to 2.46; P = 0.099; I2 = 39.8%; IVT plus EVT group, OR: 1.17; 95% CI: 0.94 to 1.45; P = 0.157; I2 = 16.0%). This meta-analysis revealed that NPAs could increase the possibility of AIS patients undergoing reperfusion therapies achieving functional independence within 90 days of onset; however, with the limited number of studies on each drug, further evidence is still needed to demonstrate the efficacy of each individual agent as an adjunctive therapy for different means of reperfusion.

Human Urinary Kallidinogenase improves vascular endothelial injury by activating the Nrf2/HO-1 signaling pathway

Vascular endothelial injury is closely related to the progression of various cardio-cerebrovascular diseases. Whether Human Urinary Kallidinogenase (HUK) has a protective effect on endothelial injury remains unclear. This study established an in vivo model of rat common carotid artery intima injury and an in vitro model of human umbilical vein endothelial cell (HUVECs) injury induced by hydrogen peroxide (H2O2). To explore the protective effect and mechanism of HUK on endothelial injury. In vivo, HUK can reduce the hyperplasia and lumen stenosis of rat common carotid artery after intimal injury, and promote the fluorescence expression of vWF in the common carotid artery. HUK also activated the Nrf2/HO-1 signaling pathway in rat common carotid artery tissue to reduce endothelial damage. In vitro, HUK can inhibit the H2O2-induced decline in HUVECs activity, improve the migration ability of HUVECs induced by H2O2, inhibit the apoptosis and necrosis of HUVECs and the generation of ROS, and regulate the expression of VEGFA, ET-1 and eNOS proteins related to endothelial function in cells. The Nrf2/HO-1 signaling pathway is activated, and the HO-1 specific inhibitor zinc porphyrin (ZnPP) can partially reverse the protective effect of HUK on H2O2-induced HUVECs injury in terms of cell migration, necrosis and oxidative stress. The Nrf2/HO-1 signaling pathway plays an important role in the regulation of migration, necrosis and oxidative stress of HUVECs cells. HUK has a protective effect on vascular endothelial injury. HUK can inhibit oxidative stress and apoptotic necrosis by activating Nrf2/HO-1 signaling pathway.

Efficacy and safety of blood-activating herbs combined with edaravone in the treatment of acute ischemic stroke: A protocol for systematic review and meta-analysis

BACKGROUND

Although the combination of blood-activating herbs and western drugs has shown advantages in the treatment of ischemic stroke, there is no consensus on the safety and efficacy. This study aimed to systematically evaluate the safety and efficacy of the combination of blood-activating herbs with edaravone (EDA) in the treatment of acute ischemic stroke (AIS).

METHODS

We will implement the search strategy in 8 English and Chinese databases: Cochrane Central Register of Controlled Trials, Web of Science, PubMed, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, EMBASE and MEDLINE. The search included relevant clinical randomized controlled trials and quasi-randomized controlled trials that had been registered for publication by November 2022. Literature screening, data extraction and quality assessment will be performed by 2 authors. We will assess the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method classification will be used to assess the quality of the literature. Meta-analysis was performed using RevMan V.5.4 and STATA 16 software.

RESULTS

This study will provide a comprehensive analysis of the current clinical evidence on the application of blood-activating herbs combined with EDA in the treatment of AIS.

CONCLUSION

This study will clarify the safety and efficacy of the combination of blood-activating herbs with EDA in the treatment of AIS.

Acupuncture at GV20 and ST36 Improves the Recovery of Behavioral Activity in Rats Subjected to Cerebral Ischemia/Reperfusion Injury

Traditional acupuncture and electroacupuncture (EA) have been widely performed to treat ischemic stroke. To provide experimental support for the clinical application of acupuncture to ameliorate post-stroke sequelae, in this study, we investigated the therapeutic effect of acupuncture and EA on CIRI following middle cerebral artery occlusion (MCAO) in rats. The animals were randomly divided into five groups: sham-operated (S), model (M), traditional acupuncture (A) treatment, electroacupuncture (EA) treatment, and drug (D; edaravone) therapies. Neurological behavioral characteristics (neurological deficit score, forelimb muscle strength, sensorimotor function, body symmetry, sucrose consumption, and mood) were examined in all the groups on days 1, 3, 5, and 7 after reperfusion. Expressions of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1α (HIF-1α) were detected by immunohistochemistry. Both acupuncture and EA significantly reduced neurological deficits and improved forelimb muscle strength, sensorimotor function, body symmetry recovery, and neurovascular regeneration in the rats after ischemia/reperfusion injury. The efficacies of both acupuncture and EA were comparable to that of edaravone, a commonly used medicine for stroke in the clinic. Thus, our data suggest that acupuncture and EA therapy at acupoints GV20 and ST36 might represent alternative or complementary treatments to the conventional management of ischemic stroke, providing additional support for the experimental evidence for acupuncture therapy in clinical settings. In summary, EA might provide alternative or complementary treatment strategies for treating patients with apoplexy in the clinic. However, potential mechanisms underlying the role of acupuncture require further investigation.

Human urinary kallidinogenase combined with edaravone in treating acute ischemic stroke patients: A meta-analysis

INTRODUCTION

Several studies have investigated the efficacy of human urinary kallidinogenase (HUK) combined with edaravone (Eda) in acute ischemic stroke (AIS) patients. Our aim was to provide the best available evidence for clinical practice and further research programs for stroke treatment.

METHODS

We searched the online database for paper published between January 2015 and April 2021. We calculated weighted mean difference (WMD) or odds risk (OR) and their corresponding 95% confidence interval (95% CI) of reported outcomes between HUK plus Eda and Eda groups for each study. The random-effect models or fixed-effect models were used to pool the analysis.

RESULTS

Thirteen studies with 1242 patients were included. In the pooled analysis, the scores of NIHSS in the HUK plus Eda group were significantly lower than that in patients receiving Eda (WMD = -3.92, 95% CI (-4.82, -3.02), p < .0001). The ADL scores in the HUK plus Eda group were significantly greater than that in patients receiving Eda (WMD = 14.13, 95% CI (10.67, 17.60), p < .0001). Furthermore, HUK plus Eda was associated with a higher rate of total efficacy (OR = 3.97, 95% CI (2.81, 5.59), p < .0001).

CONCLUSIONS

HUK combined with Eda provides potential clinical benefits as a treatment for AIS. Further high-quality, large-scale randomized trials are needed to confirm these results.