1
|
Kuriakose D, Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci 2020; 21:E7609. [PMID: 33076218 PMCID: PMC7589849 DOI: 10.3390/ijms21207609] [Citation(s) in RCA: 418] [Impact Index Per Article: 104.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Stroke is the second leading cause of death and a major contributor to disability worldwide. The prevalence of stroke is highest in developing countries, with ischemic stroke being the most common type. Considerable progress has been made in our understanding of the pathophysiology of stroke and the underlying mechanisms leading to ischemic insult. Stroke therapy primarily focuses on restoring blood flow to the brain and treating stroke-induced neurological damage. Lack of success in recent clinical trials has led to significant refinement of animal models, focus-driven study design and use of new technologies in stroke research. Simultaneously, despite progress in stroke management, post-stroke care exerts a substantial impact on families, the healthcare system and the economy. Improvements in pre-clinical and clinical care are likely to underpin successful stroke treatment, recovery, rehabilitation and prevention. In this review, we focus on the pathophysiology of stroke, major advances in the identification of therapeutic targets and recent trends in stroke research.
Collapse
Affiliation(s)
| | - Zhicheng Xiao
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC 3800, Australia;
| |
Collapse
|
2
|
Boltze J, Modo MM, Mays RW, Taguchi A, Jolkkonen J, Savitz SI. Stem Cells as an Emerging Paradigm in Stroke 4: Advancing and Accelerating Preclinical Research. Stroke 2019; 50:3299-3306. [PMID: 31658004 DOI: 10.1161/strokeaha.119.025436] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Johannes Boltze
- From the School of Life Sciences, University of Warwick, Coventry, United Kingdom (J.B.)
| | - Michel M Modo
- Departments of Radiology (M.M.M.), McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA.,Bioengineering (M.M.M.), McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA
| | - Robert W Mays
- Department of Neurosciences, Athersys, Inc, Cleveland, OH (R.W.M.)
| | - Akihiko Taguchi
- Department of Regenerative Medicine, Institute for Biomedical Research and Innovation, Kobe, Japan (A.T.)
| | - Jukka Jolkkonen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland (J.J.).,Neurocenter, Kuopio University Hospital, Finland (J.J.).,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland (J.J.)
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, UTHealth, Houston, TX (S.I.S.)
| | | |
Collapse
|
3
|
Balkaya MG, Trueman RC, Boltze J, Corbett D, Jolkkonen J. Behavioral outcome measures to improve experimental stroke research. Behav Brain Res 2018; 352:161-171. [DOI: 10.1016/j.bbr.2017.07.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 01/22/2023]
|
4
|
Tong LS, Guo ZN, Ou YB, Yu YN, Zhang XC, Tang J, Zhang JH, Lou M. Cerebral venous collaterals: A new fort for fighting ischemic stroke? Prog Neurobiol 2017; 163-164:172-193. [PMID: 29199136 DOI: 10.1016/j.pneurobio.2017.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/03/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae. Further exploration of the multi-faceted function of cerebral venous system may add new implications for stroke outcome prediction and future therapeutic decision-making. In this review, we emphasize the anatomical and functional characteristics of the cerebral venous system and illustrate its necessity in facilitating the arterial infusion and maintaining the cerebral perfusion in the pathological stroke content. We then summarize the recent critical clinical studies that underscore the associations between cerebral venous collateral and outcome of ischemic stroke with advanced imaging techniques. A novel three-level venous system classification is proposed to demonstrate the distinct characteristics of venous collaterals in the setting of ischemic stroke. Finally, we discuss the current directions for assessment of cerebral venous collaterals and provide future challenges and opportunities for therapeutic strategies in the light of these new concepts.
Collapse
Affiliation(s)
- Lu-Sha Tong
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Zhen-Ni Guo
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yi-Bo Ou
- Department of Neurosurgery, Tong-ji Hospital, Wuhan, China; Departments of Physiology, Loma Linda University, School of Medicine, CA, USA
| | - Yan-Nan Yu
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao-Cheng Zhang
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiping Tang
- Department of Anesthesiology, Loma Linda University, School of Medicine, CA, USA
| | - John H Zhang
- Departments of Physiology, Loma Linda University, School of Medicine, CA, USA.
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
| |
Collapse
|
5
|
Cell Therapy in Stroke-Cautious Steps Towards a Clinical Treatment. Transl Stroke Res 2017; 9:321-332. [PMID: 29150739 DOI: 10.1007/s12975-017-0587-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
In the future, stroke patients may receive stem cell therapy as this has the potential to restore lost functions. However, the development of clinically deliverable therapy has been slower and more challenging than expected. Despite recommendations by STAIR and STEPS consortiums, there remain flaws in experimental studies such as lack of animals with comorbidities, inconsistent approaches to experimental design, and concurrent rehabilitation that might lead to a bias towards positive results. Clinical studies have typically been small, lacking control groups as well as often without clear biological hypotheses to guide patient selection. Furthermore, they have used a wide range of cell types, doses, and delivery methods, and outcome measures. Although some ongoing and recent trial programs offer hints that these obstacles are now being tackled, the Horizon2020 funded RESSTORE trial will be given as an example of inconsistent regulatory requirements and challenges in harmonized cell production, logistic, and clinical criteria in an international multicenter study. The PISCES trials highlight the complex issues around intracerebral cell transplantation. Therefore, a better understanding of translational challenges is expected to pave the way to more successful help for stroke patients.
Collapse
|
6
|
BMP4/LIF or RA/Forskolin Suppresses the Proliferation of Neural Stem Cells Derived from Adult Monkey Brain. Stem Cells Int 2017; 2017:7012405. [PMID: 29085431 PMCID: PMC5632485 DOI: 10.1155/2017/7012405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/22/2017] [Accepted: 08/24/2017] [Indexed: 01/12/2023] Open
Abstract
Monkeys are much closer to human and are the most common nonhuman primates which are used in biomedical studies. Neural progenitor cells can originate from the hippocampus of adult monkeys. Despite a few reports, the detailed properties of monkey neural stem cells (NSCs) and their responses to cytokine are still unclear. Here, we derive NSCs from an adult monkey brain and demonstrate that BMP4 inhibits cell proliferation and affects cell morphology of monkey NSCs. Combined treatment of BMP4 and LIF or RA and Forskolin represses the proliferation of monkey NSCs. We also show that BMP4 may promote monkey NSC quiescence. Our study therefore provides implications for NSC-based cell therapy of brain injury in the future.
Collapse
|
7
|
Affiliation(s)
- Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Fumi Nakano
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| |
Collapse
|
8
|
Correcting the Trajectory of Stroke Therapeutic Research. Transl Stroke Res 2016; 8:65-66. [PMID: 28039576 DOI: 10.1007/s12975-016-0517-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 01/28/2023]
|
9
|
Challenges and Controversies in Translational Stroke Research - an Introduction. Transl Stroke Res 2016; 7:355-7. [PMID: 27581304 DOI: 10.1007/s12975-016-0492-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
|
10
|
Boltze J, Wagner DC, Henninger N, Plesnila N, Ayata C. Phase III Preclinical Trials in Translational Stroke Research: Community Response on Framework and Guidelines. Transl Stroke Res 2016; 7:241-7. [PMID: 27297402 PMCID: PMC4927600 DOI: 10.1007/s12975-016-0474-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/19/2022]
Abstract
The multicenter phase III preclinical trial concept is currently discussed to enhance the predictive value of preclinical stroke research. After public announcement, we collected a community feedback on the concept with emphasis on potential design features and guidelines by an anonymous survey. Response analysis was conducted after plausibility checks by applying qualitative and quantitative measures. Most respondents supported the concept, including the implementation of a centralized steering committee. Based on received feedback, we suggest careful, stepwise implementation and to leave selected competencies and endpoint analysis at the discretion of participating centers. Strict application of quality assurance methods is accepted, but should be harmonized. However, received responses also indicate that the application of particular quality assurance models may require more attention throughout the community. Interestingly, clear and pragmatic preferences were given regarding publication and financing, suggesting the establishing of writing committees similar to large-scale clinical trials and global funding resources for financial support. The broad acceptance among research community encourages phase III preclinical trial implementation.
Collapse
Affiliation(s)
- Johannes Boltze
- Fraunhofer Research Institution for Marine Biotechnology and Institute for Medical and Marine Biotechnology, University of Lübeck, Mönkhofer Weg 239a, 23562, Lübeck, Germany.
- Fraunhofer Institutes for Cell Therapy and Immunology, Leipzig, Germany.
| | | | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research, University of Munich Medical Center, Munich, Germany
| | - Cenk Ayata
- Neurovascular Research Lab, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|