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Wright ME, Murphy K. A mini-review of the evidence for cerebrovascular changes following gender-affirming hormone replacement therapy and a call for increased focus on cerebrovascular transgender health. Front Hum Neurosci 2023; 17:1303871. [PMID: 38077183 PMCID: PMC10702528 DOI: 10.3389/fnhum.2023.1303871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/31/2023] [Indexed: 02/12/2024] Open
Abstract
Gender-affirming hormone replacement therapy (gaHRT) is an important step for many in the gender diverse community, associated with increased quality-of-life and lower self-reported scores of depression and anxiety. However, considering the interactions that the involved sex hormones have on vasculature (with oestrogen and testosterone demonstrating vasodilatory and vasoconstricting properties, respectively), it is important for transgender healthcare research to examine how the manipulation of these hormones interact with cerebrovascular structure and functioning. There is a stark lack of research in this area. This mini-review outlines the research suggesting a vascular impact of these sex hormones using evidence from a range of cohorts (e.g., menopause, polycystic ovary syndrome) and discusses the work that has been done into cerebrovascular changes following gaHRT. Finally, recommendations for future research into cerebrovascular health in transgender cohorts following gaHRT are outlined.
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Affiliation(s)
- Melissa Emily Wright
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
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Broberg E, Hjalmarsson C, Setalani M, Milenkoski R, Andersson B. Sex Differences in Treatment and Prognosis of Acute Intracerebral Hemorrhage. J Womens Health (Larchmt) 2023; 32:102-108. [PMID: 35960812 DOI: 10.1089/jwh.2021.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Intracerebral hemorrhage (ICH) accounts for 10%-15% of all stroke cases and is associated with a high risk of death and disability. Prior studies in ischemic stroke have demonstrated a less favorable outcome in women compared with men, but there is a paucity of data regarding differences in outcome by sex in ICH. The aim of the present study was to investigate possible sex differences in acute care and the 3-months follow-up of patients with ICH. Methods: Data were collected from the Swedish National Stroke Registry (Riksstroke). Demographic and baseline characteristics were collected, based on in-hospital data and data from 3-months follow-up. Results: Variables of interest were collected from 1,403 patients. Women (45.1%) were significantly older than men, with a mean age ± standard deviation of 77 ± 13years, versus 71 ± 14 years, p < 0.01. On admission, the ICH severity was similar in men and women. There was no significant association between sex and reception of neuroimaging or neurosurgery. Women were less likely to be treated in a stroke unit (80.8% vs. 85.3%, p = 0.03), or discharged to home (51.5% vs. 63.4%, p < 0.01). At 3-months follow-up, there were no sex-related differences regarding dependence, post-ICH self-reported depression, or case fatality. Conclusions: Women were less likely to be treated in a stroke unit, and were less often discharged to home. However, no significant differences in 3-month functional outcome or survival between men and women with ICH were found in this study.
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Affiliation(s)
- Erika Broberg
- Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hjalmarsson
- Department of Cardiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mehrnoush Setalani
- Department of Geriatric, Neurology and Rehabilitation, Kungälv Hospital, Kungälv, Sweden
| | | | - Björn Andersson
- Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wilkinson CM, Kung TF, Jickling GC, Colbourne F. A translational perspective on intracranial pressure responses following intracerebral hemorrhage in animal models. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Cho S, Rehni AK, Dave KR. Tobacco Use: A Major Risk Factor of Intracerebral Hemorrhage. J Stroke 2021; 23:37-50. [PMID: 33600701 PMCID: PMC7900392 DOI: 10.5853/jos.2020.04770] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (sICH) is one of the deadliest subtypes of stroke, and no treatment is currently available. One of the major risk factors is tobacco use. In this article, we review literature on how tobacco use affects the risk of sICH and also summarize the known effects of tobacco use on outcomes following sICH. Several studies demonstrate that the risk of sICH is higher in current cigarette smokers compared to non-smokers. The literature also establishes that cigarette smoking not only increases the risk of sICH but also increases hematoma growth, results in worse outcomes, and increases the risk of death from sICH. This review also discusses potential mechanisms activated by tobacco use which result in an increase in risk and severity of sICH. Exploring the underlying mechanisms may help alleviate the risk of sICH in tobacco users as well as may help better manage tobacco user sICH patients.
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Affiliation(s)
- Sunjoo Cho
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashish K Rehni
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kunjan R Dave
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA
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Greige T, Norton C, Foster LD, Yeatts SD, Thornhill A, Griffin J, Wang J, Hrdlicka CM, Selim M. Why Are Women Less Represented in Intracerebral Hemorrhage Trials? Stroke 2021; 52:442-446. [PMID: 33493043 DOI: 10.1161/strokeaha.120.032166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage. It is unclear whether this reflects lower prevalence of intracerebral hemorrhage in women, selection bias, or poor recruitment efforts. We undertook this study to examine differences between men and women in the reasons for exclusion from the iDEF trial (Intracerebral Hemorrhage Deferoxamine). METHODS The screen failure log included 29 different reasons for exclusion. Chi-square statistics were used to evaluate the differences in reasons for exclusion between men and women. RESULTS A total of 38.2% of participants in iDEF were women. Three thousand nine hundred eighty-two women (45.7%) and 4736 men (54.3%) were screen failures (P<0.0001). Similar proportions of women (1.28%) and men (1.73%) were excluded due to inability to obtain consent (P=0.1). Patients or families declined participation in 1.26% of women versus 1.31% of men (P=0.9). More women than men failed screening because of age>80 (22.40% versus 12.61%; adjusted P=0.0007) and preexisting do-not-resuscitate/do-not-intubate (3.69% versus 2.83%; adjusted P=0.067). CONCLUSIONS Lower rates of women enrollment in the iDEF trial may be attributed to older age. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other intracerebral hemorrhage trials to determine best strategies to improve women's representation in future trials.
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Affiliation(s)
- Tatiana Greige
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Casey Norton
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Lydia D Foster
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Sharon D Yeatts
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Andre Thornhill
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Jessica Griffin
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y., A.T., J.G.)
| | - Jeffrey Wang
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Courtney M Hrdlicka
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
| | - Magdy Selim
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (T.G., C.N., J.W., C.M.H., M.S.)
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Elastin-Derived Peptide VGVAPG Affects Production and Secretion of Testosterone in Mouse Astrocyte In Vitro. Neurochem Res 2019; 45:385-394. [PMID: 31776971 DOI: 10.1007/s11064-019-02920-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022]
Abstract
Astrocytes play many distinct roles in the nervous system providing structural support for neurons and maintaining blood-brain barrier integrity. Steroid hormones exhibit a broad spectrum of actions in the central and peripheral nervous system, acting as trophic factors affecting cell differentiation and synaptic plasticity. In steroidogenesis, astrocytes play a key role by producing cholesterol, progesterone (P4), testosterone (T), and estradiol (E2). Currently there are only few studies which show that the Gly-Val-Ala-Pro-Gly (VGVAPG) peptide may affect the metabolism of astrocytes. Therefore, due to the role of neurosteroids, it is necessary to determine whether VGVAPG affects the level of E2, P4, and T in astrocytes. Primary mouse astrocytes were maintained in DMEM/F12 without phenol red, and supplemented with 10% charcoal/dextran-treated fetal bovine serum. Cells were exposed to 10 nM and 1 µM VGVAPG peptide and co-treated with cSrc kinase inhibitor I. After cell stimulation, we measured the Ki67 protein level and the production and secretion of P4, T, and E2. Our report presents the novel finding that the VGVAPG peptide affects the production and secretion of neurosteroids in astrocytes in vitro. The VGVAPG peptide increases the production of P4; however, at the same time, it decreases the secretion of P4 by astrocytes. On the other hand, it stimulates the production and secretion of T. Interestingly, the production of E2 did not change in any studied time interval. The expression of Ki67 protein increased after 48 h of exposition to the VGVAPG peptide. The cSrc kinase inhibitor I prevented most of the effects of VGVAPG peptide. Therefore, we postulate that T and cSrc kinase may be responsible for increasing astrocyte proliferation.
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Robison LS, Gannon OJ, Salinero AE, Zuloaga KL. Contributions of sex to cerebrovascular function and pathology. Brain Res 2018; 1710:43-60. [PMID: 30580011 DOI: 10.1016/j.brainres.2018.12.030] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Sex differences exist in how cerebral blood vessels function under both physiological and pathological conditions, contributing to observed sex differences in risk and outcomes of cerebrovascular diseases (CBVDs), such as vascular contributions to cognitive impairment and dementia (VCID) and stroke. Throughout most of the lifespan, women are protected from CBVDs; however, risk increases following menopause, suggesting sex hormones may play a significant role in this protection. The cerebrovasculature is a target for sex hormones, including estrogens, progestins, and androgens, where they can influence numerous vascular functions and pathologies. While there is a plethora of information on estrogen, the effects of progestins and androgens on the cerebrovasculature are less well-defined. Estrogen decreases cerebral tone and increases cerebral blood flow, while androgens increase tone. Both estrogens and androgens enhance angiogenesis/cerebrovascular remodeling. While both estrogens and androgens attenuate cerebrovascular inflammation, pro-inflammatory effects of androgens under physiological conditions have also been demonstrated. Sex hormones exert additional neuroprotective effects by attenuating oxidative stress and maintaining integrity and function of the blood brain barrier. Most animal studies utilize young, healthy, gonadectomized animals, which do not mimic the clinical conditions of aging individuals likely to get CBVDs. This is also concerning, as sex hormones appear to mediate cerebrovascular function differently based on age and disease state (e.g. metabolic syndrome). Through this review, we hope to inspire others to consider sex as a key biological variable in cerebrovascular research, as greater understanding of sex differences in cerebrovascular function will assist in developing personalized approaches to prevent and treat CBVDs.
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Affiliation(s)
- Lisa S Robison
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
| | - Olivia J Gannon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
| | - Abigail E Salinero
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
| | - Kristen L Zuloaga
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, United States.
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Xie Y, Li YJ, Lei B, Kernagis D, Liu WW, Bennett ER, Venkatraman T, Lascola CD, Laskowitz DT, Warner DS, James ML. Sex Differences in Gene and Protein Expression After Intracerebral Hemorrhage in Mice. Transl Stroke Res 2018; 10:231-239. [DOI: 10.1007/s12975-018-0633-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
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James ML, Christianson T, Woo D, Kon NKK. Gonadal hormone regulation as therapeutic strategy after acute intracerebral hemorrhage. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817725081] [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
Affiliation(s)
| | | | - Daniel Woo
- Department of Neurology, University of Cincinnati, USA
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James ML, Langefeld CD, Sekar P, Moomaw CJ, Elkind MSV, Worrall BB, Sheth KN, Martini SR, Osborne J, Woo D. Assessment of the interaction of age and sex on 90-day outcome after intracerebral hemorrhage. Neurology 2017; 89:1011-1019. [PMID: 28710330 PMCID: PMC5589792 DOI: 10.1212/wnl.0000000000004255] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 01/25/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Because age affects hormonal production differently in women compared with men, we sought to define sex and age interactions across a multiracial/ethnic population after intracerebral hemorrhage (ICH) to uncover evidence that loss of gonadal hormone production would result in loss of the known neuroprotective effects of gonadal hormones. METHODS Clinical and radiographic data from participants in the Ethnic/Racial Variations of Intracerebral Hemorrhage study and the Genetic and Environmental Risk Factors for Hemorrhagic Stroke study prior to December 2013 were used. Relationships among sex, age, and outcome after ICH in 616 non-Hispanic black, 590 Hispanic, and 868 non-Hispanic white participants were evaluated using multivariable logistic regression analysis. Poor outcome was defined as modified Rankin Scale score ≥3 at 90 days after ICH. RESULTS Sex differences were found in multiple variables among the racial/ethnic groups, including age at onset, premorbid neurologic status, and neurologic outcome after ICH. Overall, no sex-age interaction effect was found for mortality (p = 0.183) or modified Rankin Scale score (p = 0.378) at 90 days after ICH. In racial/ethnic subgroups, only the non-Hispanic black cohort provided possible evidence of a sex-age interaction on 90-day modified Rankin Scale score (p = 0.003). CONCLUSION Unlike in ischemic stroke, there was no evidence that patient sex modified the effect of age on 90-day outcomes after ICH in a large multiracial/ethnic population. Future studies should evaluate biological reasons for these differences between stroke subtypes. CLINICALTRIALSGOV IDENTIFIER NCT01202864.
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Affiliation(s)
- Michael L James
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX.
| | - Carl D Langefeld
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Padmini Sekar
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Charles J Moomaw
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Mitchell S V Elkind
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Bradford B Worrall
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Kevin N Sheth
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Sharyl R Martini
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
| | - Jennifer Osborne
- From the Brain Injury Translational Research Center, Department of Anesthesiology, and Department of Neurology (M.L.J.), Duke University, Durham; Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati, OH; Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University, New Haven, CT; and Department of Neurology (S.R.M.), Baylor College of Medicine, Houston, TX
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Cai J, Li J, Chen S, Meng J, Ren R, Li M. Early post-haemorrhagic stroke testosterone and oestradiol levels and long-term risk of death. Brain Inj 2017; 31:401-405. [PMID: 28296530 DOI: 10.1080/02699052.2016.1265668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jing Cai
- Neurointensive Care Unit, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Jingbo Li
- Neurointensive Care Unit, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Shuda Chen
- Neurointensive Care Unit, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Jing Meng
- Neurointensive Care Unit, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Reng Ren
- Neurointensive Care Unit, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, PR China
| | - Min Li
- Neurointensive Care Unit, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, PR China
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Hsieh JT, Ang BT, Ng YP, Allen JC, King NKK. Comparison of Gender Differences in Intracerebral Hemorrhage in a Multi-Ethnic Asian Population. PLoS One 2016; 11:e0152945. [PMID: 27050549 PMCID: PMC4822850 DOI: 10.1371/journal.pone.0152945] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) accounts for 10-15% of all first time strokes and with incidence twice as high in the Asian compared to Western population. This study aims to investigate gender differences in ICH patient outcomes in a multi-ethnic Asian population. METHOD Data for 1,192 patients admitted for ICH were collected over a four-year period. Multivariate logistic regression was used to identify independent predictors and odds ratios were computed for 30-day mortality and Glasgow Outcome Scale (GOS) comparing males and females. RESULT Males suffered ICH at a younger age than females (62.2 ± 13.2 years vs. 66.3 ± 15.3 years; P<0.001). The occurrence of ICH was higher among males than females at all ages until 80 years old, beyond which the trend was reversed. Females exhibited increased severity on admission as measured by Glasgow Coma Scale compared to males (10.9 ± 4.03 vs. 11.4 ± 4.04; P = 0.030). No difference was found in 30-day mortality between females and males (F: 30.5% [155/508] vs. M: 27.0% [186/688]), with unadjusted and adjusted odds ratio (F/M) of 1.19 (P = 0.188) and 1.21 (P = 0.300). At discharge, there was a non-statistically significant but potentially clinically relevant morbidity difference between the genders as measured by GOS (dichotomized GOS of 4-5: F: 23.7% [119/503] vs. M: 28.7% [194/677]), with unadjusted and adjusted odds ratio (F/M) of 0.77 (P = 0.055) and 0.87 (P = 0.434). CONCLUSION In our multi-ethnic Asian population, males developed ICH at a younger age and were more susceptible to ICH than women at all ages other than the beyond 80-year old age group. In contrast to the Western population, neurological status of female ICH patients at admission was poorer and their 30-day mortality was not reduced. Although the study was not powered to detect significance, female showed a trend toward worse 30-day morbidity at discharge.
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Affiliation(s)
- Justin T. Hsieh
- School of Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
- * E-mail:
| | - Beng Ti Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Yew Poh Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - John C. Allen
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Nicolas K. K. King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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Lei B, Wang H, Jeong S, Hsieh JT, Majeed M, Dawson H, Sheng H, Warner DS, James ML. Progesterone Improves Neurobehavioral Outcome in Models of Intracerebral Hemorrhage. Neuroendocrinology 2016; 103:665-77. [PMID: 26562172 DOI: 10.1159/000442204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/05/2015] [Indexed: 11/19/2022]
Abstract
In models of acute brain injury, progesterone improves recovery through several mechanisms including modulation of neuroinflammation. Secondary injury from neuroinflammation is a potential therapeutic target after intracerebral hemorrhage (ICH). For potential translation of progesterone as a clinical acute ICH therapeutic, the present study sought to define efficacy of exogenous progesterone administration in ICH-relevant experimental paradigms. Young and aged C57BL/6 male, female, and ovariectomized (OVX) mice underwent left intrastriatal collagenase (0.05-0.075 U) or autologous whole blood (35 μl) injection. Progesterone at varying doses (4-16 mg/kg) was administered at 2, 5, 24, 48, and 72 h after injury. Rotarod and Morris water maze latencies were measured on days 1-7 and days 28-31 after injury, respectively. Hematoma volume, brain water content (cerebral edema), complementary immunohistochemistry, multiplex cytokine arrays, and inflammatory proteins were assessed at prespecified time points after injury. Progesterone (4 mg/kg) administration improved rotarod and water maze latencies (p < 0.01), and decreased cerebral edema (p < 0.05), microglial proliferation, and neuronal loss (p < 0.01) in young and aged male, young OVX, and aged female mice. Brain concentration of proinflammatory cytokines and Toll-like receptor-associated proteins were also decreased after progesterone (4 mg/kg) treatment (p < 0.01). Progesterone-treated young female mice showed no detectable effects. Exogenous progesterone improved short- and long-term neurobehavioral recovery and modulated neuroinflammation in male and OVX mice after ICH. Future studies should validate these findings, and address timing and length of administration before translation to clinical trial.
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Affiliation(s)
- Beilei Lei
- Multidisciplinary Neuroprotection Laboratories, Duke University, Durham, N.C., USA
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Hsieh JT, Lei B, Sheng H, Venkatraman T, Lascola CD, Warner DS, James ML. Sex-Specific Effects of Progesterone on Early Outcome of Intracerebral Hemorrhage. Neuroendocrinology 2016; 103:518-30. [PMID: 26356626 DOI: 10.1159/000440883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preclinical evidence suggests that progesterone improves recovery after intracerebral hemorrhage (ICH); however, gonadal hormones have sex-specific effects. Therefore, an experimental model of ICH was used to assess recovery after progesterone administration in male and female rats. METHODS ICH was induced in male and female Wistar rats via stereotactic intrastriatal injection of clostridial collagenase (0.5 U). Animals were randomized to receive vehicle or 8 mg/kg progesterone intraperitoneally at 2 h, then subcutaneously at 5, 24, 48, and 72 h after injury. Outcomes included relevant physiology during the first 3 h, hemorrhage and edema evolution over the first 24 h, proinflammatory transcription factor and cytokine regulation at 24 h, rotarod latency and neuroseverity score over the first 7 days, and microglial activation/macrophage recruitment at 7 days after injury. RESULTS Rotarod latency (p = 0.001) and neuroseverity score (p = 0.01) were improved in progesterone-treated males, but worsened in progesterone-treated females (p = 0.028 and p = 0.008, respectively). Progesterone decreased cerebral edema (p = 0.04), microglial activation/macrophage recruitment (p < 0.001), and proinflammatory transcription factor phosphorylated nuclear factor-x03BA;B p65 expression (p = 0.0038) in males but not females, independent of tumor necrosis factor-α, interleukin-6, and toll-like receptor-4 expression. Cerebral perfusion was increased in progesterone-treated males at 4 h (p = 0.043) but not 24 h after injury. Hemorrhage volume, arterial blood gases, glucose, and systolic blood pressure were not affected. CONCLUSIONS Progesterone administration improved early neurobehavioral recovery and decreased secondary neuroinflammation after ICH in male rats. Paradoxically, progesterone worsened neurobehavioral recovery and did not modify neuroinflammation in female rats. Future work should isolate mechanisms of sex-specific progesterone effects after ICH.
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Gokhale S, Caplan LR, James ML. Sex Differences in Incidence, Pathophysiology, and Outcome of Primary Intracerebral Hemorrhage. Stroke 2015; 46:886-92. [DOI: 10.1161/strokeaha.114.007682] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sankalp Gokhale
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Louis R. Caplan
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Michael L. James
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
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Gürer B, Kertmen H, Kasim E, Yilmaz ER, Kanat BH, Sargon MF, Arikok AT, Ergüder BI, Sekerci Z. Neuroprotective effects of testosterone on ischemia/reperfusion injury of the rabbit spinal cord. Injury 2015; 46:240-8. [PMID: 25467821 DOI: 10.1016/j.injury.2014.11.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/25/2014] [Accepted: 11/03/2014] [Indexed: 02/02/2023]
Abstract
AIM Previous studies demonstrated the neuroprotective effects of testosterone, but no previous study has examined the neuroprotective effects of testosterone on spinal cord ischemia/reperfusion injury. The purpose of this study was to evaluate whether testosterone could protect the spinal cord from ischemia/reperfusion injury. METHODS Rabbits were randomised into four groups of eight animals as follows: group 1 (control), group 2 (ischemia), group 3 (methylprednisolone) and group 4 (testosterone). In the control group only a laparotomy was performed. In all other groups, the spinal cord ischemia model was created by the occlusion of the aorta just caudal to the renal artery. Levels of malondialdehyde and catalase were analysed, as were the activities of caspase-3, myeloperoxidase, and xanthine oxidase. Histopathological and ultrastructural evaluations were performed. Neurological evaluation was performed with the Tarlov scoring system. RESULTS After ischemia-reperfusion injury, increases were found in caspase-3 activity, myeloperoxidase activity, malondialdehyde levels, and xanthine oxidase activity. In contrast, decreases in catalase levels were observed. After the administration of testosterone, decreases were observed in caspase-3 activity, myeloperoxidase activity, malondialdehyde levels, and xanthine oxidase activity, whereas catalase levels increased. Furthermore, testosterone treatment showed improved results concerning histopathological scores, ultrastructural score and Tarlov scores. CONCLUSIONS Our results revealed for the first time that testosterone exhibits meaningful neuroprotective activity following ischemia-reperfusion injury of the spinal cord.
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Affiliation(s)
- Bora Gürer
- Ministry of Health, Fatih Sultan Mehmet Education and Research Hospital, Neurosurgey Clinic, Istanbul, Turkey.
| | - Hayri Kertmen
- Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Neurosurgey Clinic, Ankara, Turkey
| | - Emin Kasim
- Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Neurosurgey Clinic, Ankara, Turkey
| | - Erdal Resit Yilmaz
- Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Neurosurgey Clinic, Ankara, Turkey
| | - Burhan Hakan Kanat
- Ministry of Health, Elazig Education and Research Hospital, General Surgery Clinic, Elazig, Turkey
| | - Mustafa Fevzi Sargon
- Hacettepe University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Ata Türker Arikok
- Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Department of Pathology, Ankara, Turkey
| | - Berrin Imge Ergüder
- Ankara University, Faculty of Medicine, Department of Biochemistry, Ankara, Turkey
| | - Zeki Sekerci
- Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Neurosurgey Clinic, Ankara, Turkey
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Gürer B, Turkoglu E, Kertmen H, Karavelioglu E, Arikok AT, Sekerci Z. Attenuation of cerebral vasospasm and secondary injury by testosterone following experimental subarachnoid hemorrhage in rabbit. Acta Neurochir (Wien) 2014; 156:2111-20; discussion 2120. [PMID: 25194970 DOI: 10.1007/s00701-014-2211-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/19/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND The vasodilatator effects of testosterone have been widely studied and demonstrated. Based on previous studies of these vasodilatatory activities, we hypothesized that testosterone might have potential effects on subarachnoid hemorrhage-induced cerebral vasospasm. METHODS Thirty-two adult male New Zealand white rabbits were randomly divided into four groups of eight rabbits in each group: group 1 (control); group 2 (subarachnoid hemorrhage); group 3 (subarachnoid hemorrhage + vehicle); and group 4 (subarachnoid hemorrhage + testosterone). Testosterone (15 mg/kg, intraperitoneally) was administered 5 min after the intracisternal blood injection and continued for 72 h once per day in the same dose for group 4. Animals were killed 72 h after subarachnoid hemorrhage. Basilar artery cross-sectional areas, arterial wall thicknesses, and hippocampal degeneration scores were evaluated in all groups. RESULTS Intraperitoneal administration of testosterone was found to attenuate cerebral vasospasm and provide neuroprotection after subarachnoid hemorrhage in rabbits. Testosterone treatment was determined to be effective at increasing the luminal area and reducing the wall thickness of the basilar artery. CONCLUSIONS Our findings show that testosterone has some preventive effects on SAH-induced vasospasm and secondary neuronal injury in rabbits. We propose that the vasodilatatory activity of testosterone is due to its effects on inhibiting calcium channels, activating potassium channels, augmenting nitric oxide synthesis, and inhibiting oxidant stress and inflammation.
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Gender and age interact to affect early outcome after intracerebral hemorrhage. PLoS One 2013; 8:e81664. [PMID: 24312335 PMCID: PMC3842307 DOI: 10.1371/journal.pone.0081664] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/15/2013] [Indexed: 11/19/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a common and devastating form of cerebrovascular disease. In ICH, gender differences in outcomes remain relatively understudied but have been examined in other neurological emergencies. Further, a potential effect of age and gender on outcomes after ICH has not been explored. This study was designed to test the hypothesis that age and gender interact to modify neurological outcomes after ICH. Methods Adult patients admitted with spontaneous primary supratentorial ICH from July 2007 through April 2010 were assessed via retrospective analysis of an existing stroke database at Duke University. Univariate analysis of collected variables was used to compare gender and outcome. Unfavorable outcome was defined as discharge to hospice or death. Using multivariate regression, the combined effect of age and gender on outcome after ICH was analyzed. Results In this study population, women were younger (61.1+14.5 versus 65.8+17.3 years, p=0.03) and more likely to have a history of substance abuse (35% versus 8.9%, p<0.0001) compared to men. Multivariable models demonstrated that advancing age had a greater effect on predicting discharge outcome in women compared to men (p=0.02). For younger patients, female sex was protective; however, at ages greater than 60 years, female sex was a risk factor for discharge to hospice or death. Conclusion While independently associated with discharge to hospice or death after ICH, the interaction effect between gender and age demonstrated significantly stronger correlation with early outcome after ICH in a single center cohort. Prospective study is required to verify these findings.
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Effects of androgens on early post-ischemic neurogenesis in mice. Transl Stroke Res 2013; 5:301-11. [PMID: 24323721 DOI: 10.1007/s12975-013-0298-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/11/2013] [Accepted: 10/16/2013] [Indexed: 12/22/2022]
Abstract
Although androgens are reported to affect stroke outcomes by altering ischemic tissue damage, their effect on post-injury repair is unknown. Since neurogenesis has recently been recognized as contributing to stroke outcomes, we investigated the role of androgens on stroke-induced neurogenesis. Adult male mice were subjected to transient middle cerebral artery occlusion (MCAO) and neurogenesis was examined 1 week later by quantifying BrdU/doublecortin-positive and BrdU/NeuN-positive neurons in brain germinal regions as well as the injured striatum. To elucidate the role of endogenous androgens, post-MCAO neurogenesis was examined in gonadally intact males, intact males implanted with the androgen receptor antagonist flutamide, and surgically castrated males. Surgical castration or pharmacologic androgen receptor blockade had no effects on post-ischemic neurogenesis, except that continuous androgen receptor blockade unexpectedly suppressed maturation of newborn neurons (BrdU/NeuN-positive cells) in the dentate gyrus. Post-MCAO neurogenesis was also examined in surgically castrated mice treated with continuous release implants containing testosterone or dihydrotestosterone (DHT). Testosterone and DHT robustly inhibited post-ischemic neurogenesis in the dentate gyrus, and the more potent androgen DHT virtually abolished the presence of immature newborn neurons (BrdU/doublecortin-positive cells) in the injured striatum. Our data suggest that endogenous androgens do not alter post-stroke neurogenesis quantitatively, but the presence of supra-physiological androgen stimulation profoundly suppresses early neurogenesis in germinal brain areas and reduces cellular repair in injured tissue after cerebral ischemia. These results advance the understanding of the role that androgens play in stroke outcomes.
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Deutsch ER, Espinoza TR, Atif F, Woodall E, Kaylor J, Wright DW. Progesterone's role in neuroprotection, a review of the evidence. Brain Res 2013; 1530:82-105. [PMID: 23872219 DOI: 10.1016/j.brainres.2013.07.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
The sex hormone progesterone has been shown to improve outcomes in animal models of a number of neurologic diseases, including traumatic brain injury, ischemia, spinal cord injury, peripheral nerve injury, demyelinating disease, neuromuscular disorders, and seizures. Evidence suggests it exerts its neuroprotective effects through several pathways, including reducing edema, improving neuronal survival, and modulating inflammation and apoptosis. In this review, we summarize the functional outcomes and pathophysiologic mechanisms attributed to progesterone treatment in neurologic disease. We then comment on the breadth of evidence for the use of progesterone in each neurologic disease family. Finally, we provide support for further human studies using progesterone to treat several neurologic diseases.
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Affiliation(s)
- Eric R Deutsch
- Emergency Neurosciences, Department of Emergency Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, FOB Suite 126, Atlanta, GA 30303, USA.
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Abstract
The likelihood of translating therapeutic interventions for stroke rests on the quality of preclinical science. Given the limited success of putative treatments for ischemic stroke and the reasons put forth to explain it, we sought to determine whether such problems hamper progress for intracerebral hemorrhage (ICH). Approximately 10% to 20% of strokes result from an ICH, which results in considerable disability and high mortality. Several animal models reproduce ICH and its underlying pathophysiology, and these models have been widely used to evaluate treatments. As yet, however, none has successfully translated. In this review, we focus on rodent models of ICH, highlighting differences among them (e.g., pathophysiology), issues with experimental design and analysis, and choice of end points. A Pub Med search for experimental ICH (years: 2007 to 31 July 2011) found 121 papers. Of these, 84% tested neuroprotectants, 11% tested stem cell therapies, and 5% tested rehabilitation therapies. We reviewed these to examine study quality (e.g., use of blinding procedures) and choice of end points (e.g., behavioral testing). Not surprisingly, the problems that have plagued the ischemia field are also prevalent in ICH literature. Based on these data, several recommendations are put forth to facilitate progress in identifying effective treatments for ICH.
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Kaore SN, Langade DK, Yadav VK, Sharma P, Thawani VR, Sharma R. Novel actions of progesterone: what we know today and what will be the scenario in the future? J Pharm Pharmacol 2012; 64:1040-62. [DOI: 10.1111/j.2042-7158.2012.01464.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abstract
Objectives
This article is aimed to review the novel actions of progesterone, which otherwise is considered as a female reproductive hormone. The article focuses on its important physiological actions in males too and gives an overview of its novel perspectives in disorders of central and peripheral nervous system.
Key findings
Progesterone may have a potential benefit in treatment of traumatic brain injury, various neurological disorders and male related diseases like benign prostatic hypertrophy (BPH), prostate cancer and osteoporosis. Norethisterone (NETA), a progesterone derivative, decreases bone mineral loss in male castrated mice suggesting its role in osteoporosis. In the future, progesterone may find use as a male contraceptive too, but still needs confirmatory trials for safety, tolerability and acceptability. Megestrol acetate, a progesterone derivative is preferred in prostatic cancer. Further, it may find utility in nicotine addiction, traumatic brain injury (recently entered Phase III trial) and Alzheimer's disease, diabetic neuropathy and crush injuries. Studies also suggest role of progesterone in stroke, for which further clinical trials are needed. The non genomic actions of progesterone may be in part responsible for these novel actions.
Summary
Although progesterone has shown promising role in various non-hormonal benefits, further clinical studies are needed to prove its usefulness in conditions like stroke, traumatic brain injury, neuropathy and crush injury. In male related illnesses like BPH and prostatic Ca, it may prove a boon in near future. New era of hormonal male contraception may be initiated by use of progesterone along with testosterone.
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Affiliation(s)
- Shilpa N Kaore
- Department of Pharmacology, Peoples College of Medical Sciences & Research Center, Bhopal, Madhya Pradesh, India
| | - Deepak Kumar Langade
- Department of Pharmacology, Peoples College of Medical Sciences & RC, Bhopal, Madhya Pradesh, India
| | - Vijay Kumar Yadav
- Department of Pharmacology, Peoples College of Medical Sciences & RC, Bhopal, Madhya Pradesh, India
| | - Parag Sharma
- Department of Pharmacology, Peoples College of Medical Sciences & RC, Bhopal, Madhya Pradesh, India
| | - Vijay R Thawani
- Department of Pharmacology, VCSG GMSRI, Srinagar and Pauri Garhwal, Uttarakhand, India
| | - Raj Sharma
- Department of Pharmacology, Govt medical College, Jagdalpur, Chhatisgarh, India
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Kirkman MA, Allan SM, Parry-Jones AR. Experimental intracerebral hemorrhage: avoiding pitfalls in translational research. J Cereb Blood Flow Metab 2011; 31:2135-51. [PMID: 21863040 PMCID: PMC3210340 DOI: 10.1038/jcbfm.2011.124] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 07/20/2011] [Accepted: 07/28/2011] [Indexed: 12/12/2022]
Abstract
Intracerebral hemorrhage (ICH) has the highest mortality of all stroke subtypes, yet treatments are mainly limited to supportive management, and surgery remains controversial. Despite significant advances in our understanding of ICH pathophysiology, we still lack preclinical models that accurately replicate the underlying mechanisms of injury. Current experimental ICH models (including autologous blood and collagenase injection) simulate different aspects of ICH-mediated injury but lack some features of the clinical condition. Newly developed models, notably hypertension- and oral anticoagulant therapy-associated ICH models, offer added benefits but further study is needed to fully validate them. Here, we describe and discuss current approaches to experimental ICH, with suggestions for changes in how this condition is studied in the laboratory. Although advances in imaging over the past few decades have allowed greater insight into clinical ICH, there remains an important role for experimental models in furthering our understanding of the basic pathophysiologic processes underlying ICH, provided limitations of animal models are borne in mind. Owing to differences in existing models and the failed translation of benefits in experimental ICH to clinical practice, putative neuroprotectants should be trialed in multiple models using both histological and functional outcomes until a more accurate model of ICH is developed.
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Affiliation(s)
- Matthew A Kirkman
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Stuart M Allan
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Adrian R Parry-Jones
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
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