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Wypych M, Domitrz I, Kochanowski J. Insulin-like growth factor 1 and its prognostic value in the course of acute ischemic cerebrovascular events. Arch Med Sci Atheroscler Dis 2023; 8:e146-e154. [PMID: 38283930 PMCID: PMC10811535 DOI: 10.5114/amsad/172970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The aim of the study was to evaluate insulin-like growth factor 1 (IGF-1) as a predictor of the course of an acute cerebral ischemic event (AICE). This polypeptide, by activating receptors that are present in most tissues, including the brain, mediates the anabolic activity of growth hormone (GH) and its impact on growth and maturation processes, as well as organisms' survival time. AICE can occur in the form of a transient ischemic attack (TIA) or an ischemic stroke (IS). Material and methods The study included 86 participants. The correlation between serum IGF-1 concentration and the clinical status of 56 patients on days 1 and 9 of AICE, as well as risk factors and the course of the disease, were prospectively analyzed. The control group consisted of 30 healthy volunteers. Results Patients with a minor baseline neurological syndrome had higher serum IGF-1 concentrations than patients with severe baseline neurological dysfunctions. Multidimensional analyses showed that high IGF-1 values independently determined the worse course of the disease, especially in patients with a severe neurological deficit present on the first day of AICE. Conclusions Our results indicate that the high level of circulating IGF-1 on the first day of AICE is an independent factor determining the unfavorable course of the stroke, and this relationship is proportional to the severity of the baseline neurological deficit. The study also revealed a positive correlation between the decreased plasma IGF-1 concentration on the first day of AICE and the severity of neurological symptoms.
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Affiliation(s)
- Martyna Wypych
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Domitrz
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Jan Kochanowski
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
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Włodarczyk L, Cichoń N, Karbownik MS, Saso L, Saluk J, Miller E. Circulating Serum VEGF, IGF-1 and MMP-9 and Expression of Their Genes as Potential Prognostic Markers of Recovery in Post-Stroke Rehabilitation-A Prospective Observational Study. Brain Sci 2023; 13:846. [PMID: 37371326 DOI: 10.3390/brainsci13060846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
The key period in post-stroke recovery is the first three months due to the high activity of spontaneous and therapeutic-induced processes related to neuroplasticity, angiogenesis and reperfusion. Therefore, the present study examines the expression of VEGF, IGF-1 and MMP-9 proteins and their genes to identify biomarkers that can prognose brain repair ability and thus estimate the outcome of stroke. It also identifies possible associations with clinical scales, including cognitive assessment and depression scales. The study group comprised 32 patients with moderate ischemic stroke severity, three to four weeks after incident. The results obtained after three-week hospitalization indicate a statistically significant change in clinical parameter estimations, as well as in MMP9 and VEGF protein and mRNA expression, over the rehabilitation process. Our findings indicate that combined MMP9 protein and mRNA expression might be a useful biomarker for cognitive improvement in post-stroke patients, demonstrating 87% sensitivity and 71% specificity (p < 0.0001).
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Affiliation(s)
- Lidia Włodarczyk
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Natalia Cichoń
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Michał Seweryn Karbownik
- Department of Pharmacology and Toxicology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland
| | - Luciano Saso
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University, P. le Aldo Moro 5, 00185 Rome, Italy
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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3
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Åberg D, Gadd G, Jood K, Redfors P, Stanne TM, Isgaard J, Blennow K, Zetterberg H, Jern C, Åberg ND, Svensson J. Serum IGFBP-1 Concentration as a Predictor of Outcome after Ischemic Stroke-A Prospective Observational Study. Int J Mol Sci 2023; 24:ijms24119120. [PMID: 37298072 DOI: 10.3390/ijms24119120] [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: 03/30/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Insulin-like growth factor-binding protein-1 (IGFBP-1) regulates insulin-like growth factor-I (IGF-I) bioactivity, and is a central player in normal growth, metabolism, and stroke recovery. However, the role of serum IGFBP-1 (s-IGFBP-1) after ischemic stroke is unclear. We determined whether s-IGFBP-1 is predictive of poststroke outcome. The study population comprised patients (n = 470) and controls (n = 471) from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Functional outcome was evaluated after 3 months, 2, and 7 years using the modified Rankin Scale (mRS). Survival was followed for a minimum of 7 years or until death. S-IGFBP-1 was increased after 3 months (p < 0.01), but not in the acute phase after stroke, compared with the controls. Higher acute s-IGFBP-1 was associated with poor functional outcome (mRS score > 2) after 7 years [fully adjusted odds ratio (OR) per log increase 2.9, 95% confidence interval (CI): 1.4-5.9]. Moreover, higher s-IGFBP-1 after 3 months was associated with a risk of poor functional outcome after 2 and 7 years (fully adjusted: OR 3.4, 95% CI: 1.4-8.5 and OR 5.7, 95% CI: 2.5-12.8, respectively) and with increased mortality risk (fully adjusted: HR 2.0, 95% CI: 1.1-3.7). Thus, high acute s-IGFBP-1 was only associated with poor functional outcome after 7 years, whereas s-IGFBP-1 after 3 months was an independent predictor of poor long-term functional outcome and poststroke mortality.
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Affiliation(s)
- Daniel Åberg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Specialist Medicine, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Gustaf Gadd
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Tara M Stanne
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Jörgen Isgaard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Specialist Medicine, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Kaj Blennow
- Region Västra Götaland, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Sweden
| | - Henrik Zetterberg
- Region Västra Götaland, Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 431 80 Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- UK Dementia Research Institute, University College London (UCL), London WC1E 6BT, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706-1380, USA
| | - Christina Jern
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
- Region Västra Götaland, Department of Genetics and Genomics, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - N David Åberg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Johan Svensson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 5, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Internal Medicine, Skaraborg Central Hospital, 541 42 Skövde, Sweden
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Li Y, Yang W, Li J, Zhang Y, Zhang L, Chen S, He L, Zhang Y. Relationship between serum insulin-like growth factor 1 levels and ischaemic stroke: a systematic review and meta-analysis. BMJ Open 2022; 12:e045776. [PMID: 35705353 PMCID: PMC9204407 DOI: 10.1136/bmjopen-2020-045776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the association of insulin-like growth factor 1 (IGF-1) with the risk of incident ischaemic stroke and outcome after ischaemic stroke. DESIGN A systematic review of primary studies. SETTING Hospitals in Western Sweden, Italy, China and Denmark. METHODS A search was carried out in eligible studies in electronic databases (PubMed, Scopus, Embase, China National Knowledge Infrastructure and Web of Science) updated to 29 December 2020. The relevant data were extracted in order to conduct the meta-analysis. Review Manager V.5.2 was used to pool data and calculate the mean difference (MD) and its 95% CI. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were also performed in this meta-analysis. RESULTS A total of 2277 patients were included in 17 studies. This meta-analysis indicated that higher serum IGF-1 levels were significantly correlated with less risk of ischaemic stroke (MD=-45.32 95% CI -63.70 to -26.94], p < 0.00001, I2=99%) and better improvement of outcome after ischaemic stroke (MD=27.52, 95% CI 3.89 to 51.14, p=0.02, I2=96%). According to subgroup analysis, heterogeneity comes from country, sample size, male and the time from symptom onset to blood collection. Sensitivity analysis showed that there was no significant influence of any individual study on the pooled MD. The effect of high heterogeneity on result credibility was eliminated when four included studies were merged (MD=-30.32, 95% CI -36.52 to -24.11, p< 0.00001, I2=0%). Moreover, no potential publication bias was discovered in this meta-analysis. CONCLUSION Higher serum IGF-1 was significantly correlated with a lower risk of ischaemic stroke. In view of the high degree of heterogeneity, it may need more studies to confirm the prognostic value of serum IGF-1 levels in ischaemic stroke and explore the sources of heterogeneity.
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Affiliation(s)
- Yangni Li
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Weinan Yang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinhui Li
- Department of Rehabilitation and Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yishu Zhang
- Zhejiang Chinese Medical University, Hangzhou, China
| | | | - Simiao Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Lan He
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuyan Zhang
- Zhejiang Chinese Medical University, Hangzhou, China
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5
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Hayes CA, Valcarcel-Ares MN, Ashpole NM. Preclinical and clinical evidence of IGF-1 as a prognostic marker and acute intervention with ischemic stroke. J Cereb Blood Flow Metab 2021; 41:2475-2491. [PMID: 33757314 PMCID: PMC8504958 DOI: 10.1177/0271678x211000894] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ischemic strokes are highly prevalent in the elderly population and are a leading cause of mortality and morbidity worldwide. The risk of ischemic stroke increases in advanced age, corresponding with a noted decrease in circulating insulin growth factor-1 (IGF-1). IGF-1 is a known neuroprotectant involved in embryonic development, neurogenesis, neurotransmission, cognition, and lifespan. Clinically, several studies have shown that reduced levels of IGF-1 correlate with increased mortality rate, poorer functional outcomes, and increased morbidities following an ischemic stroke. In animal models of ischemia, administering exogenous IGF-1 using various routes of administration (intranasal, intravenous, subcutaneous, or topical) at various time points prior to and following insult attenuates neurological damage and accompanying behavioral changes caused by ischemia. However, there are some contrasting findings in select clinical and preclinical studies. This review discusses the role of IGF-1 as a determinant factor of ischemic stroke outcomes, both within the clinical settings and preclinical animal models. Furthermore, the review provides insight on the role of IGF-1 in mechanisms and cellular processes that contribute to stroke damage.
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Affiliation(s)
- Cellas A Hayes
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Mississippi, USA
| | - M Noa Valcarcel-Ares
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Mississippi, USA
| | - Nicole M Ashpole
- Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, Mississippi, USA.,Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, University, Mississippi, USA
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Lee J, Lee J, Lee M, Lim JS, Kim JH, Yu KH, Oh MS, Lee BC. Association between Serum Insulin-Like Growth Factor-1 and Neurological Severity in Acute Ischemic Stroke. J Clin Neurol 2021; 17:206-212. [PMID: 33835740 PMCID: PMC8053552 DOI: 10.3988/jcn.2021.17.2.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose Serum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS). Methods This study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis. Results This study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24–0.80, p=0.01), while there was no significant association at 3 months. Conclusions This study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.
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Affiliation(s)
- Jeeun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jeongjae Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jin Hyouk Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
| | - Byung Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
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7
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Åberg ND, Wall A, Anger O, Jood K, Andreasson U, Blennow K, Zetterberg H, Isgaard J, Jern C, Svensson J. Circulating levels of vascular endothelial growth factor and post-stroke long-term functional outcome. Acta Neurol Scand 2020; 141:405-414. [PMID: 31919840 DOI: 10.1111/ane.13219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/23/2019] [Accepted: 01/05/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Vascular endothelial growth factor (VEGF) acts in angiogenesis and neuroprotection, although the beneficial effects on experimental ischemic stroke (IS) have not been replicated in clinical studies. We investigated serum VEGF (s-VEGF) in the acute stage (baseline) and 3 months post-stroke in relation to stroke severity and functional outcome. METHODS The s-VEGF and serum high-sensitivity C-reactive protein (hs-CRP) concentrations were measured in patients enrolled in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) at the acute time-point (median 4 days, N = 492, 36% female; mean age, 57 years) and at 3 months post-stroke (N = 469). Baseline stroke severity was classified according to the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes (3 months and 2 years) were evaluated using the modified Rankin Scale (mRS), dichotomized into good (mRS 0-2), and poor (mRS 3-6) outcomes. Multivariable logistic regression analyses were adjusted for covariates. RESULTS The baseline s-VEGF did not correlate with stroke severity but correlated moderately with hs-CRP (r = .17, P < .001). The baseline s-VEGF was 39.8% higher in total anterior cerebral infarctions than in lacunar cerebral infarctions. In binary logistic regression analysis, associations with 3-month functional outcome were non-significant. However, an association between the 3-month s-VEGF and poor 2-year outcome withstood adjustments for age, sex, cardiovascular covariates, and stroke severity (per 10-fold increase in s-VEGF, odds ratio [OR], 2.56, 95% confidence interval [CI] 1.12-5.82) or hs-CRP (OR 2.53, CI 1.15-5.55). CONCLUSIONS High 3-month s-VEGF is independently associated with poor 2-year functional outcome but not with 3-month outcome.
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Affiliation(s)
- N. David Åberg
- Department of Internal Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Alexander Wall
- Department of Internal Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Olof Anger
- Department of Internal Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Katarina Jood
- Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department for Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ulf Andreasson
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Mölndal Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Mölndal Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Department of Laboratory Medicine Institute of Biomedicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurodegenerative Disease UCL Institute of Neurology London UK
- UK Dementia Research Institute at UCL London UK
| | - Jörgen Isgaard
- Department of Internal Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Christina Jern
- Department of Laboratory Medicine Institute of Biomedicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Clinical Genetics and Genomics Sahlgrenska University Hospital Gothenburg Sweden
| | - Johan Svensson
- Department of Internal Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
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8
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Åberg ND, Gadd G, Åberg D, Hällgren P, Blomstrand C, Jood K, Nilsson M, Walker FR, Svensson J, Jern C, Isgaard J. Relationship between Levels of Pre-Stroke Physical Activity and Post-Stroke Serum Insulin-Like Growth Factor I. Biomedicines 2020; 8:biomedicines8030052. [PMID: 32143318 PMCID: PMC7148508 DOI: 10.3390/biomedicines8030052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Physical activity (PA) and insulin-like growth factor I (IGF-I) have beneficial effects for patients who have suffered an ischemic stroke (stroke). However, the relationship between the levels of PA and IGF-I after stroke has not been explored in detail. We investigated the pre-stroke PA level in relation to the post-stroke serum IGF-I (s-IGF-I) level, at baseline and at 3 months after the index stroke, and calculated the change that occurred between these two time-points (ΔIGF-I). Patients (N = 380; 63.4% males; mean age, 54.7 years) with data on 1-year leisure-time pre-stroke PA and post-stroke s-IGF-I levels were included from the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Pre-stroke, leisure-time PA was self-reported as PA1–4, with PA1 representing sedentary and PA2–4 indicating progressively higher PA levels. Associations between s-IGF-I and PA were evaluated by multiple linear regressions with PA1 as the reference and adjustments being made for sex, age, history of previous stroke or myocardial infarctions, cardiovascular risk factors, and stroke severity. PA correlated with baseline s-IGF-I and ΔIGF-I, but not with the 3-month s-IGF-I. In the linear regressions, there were corresponding associations that remained as a tendency (baseline s-IGF-I, p = 0.06) or as a significant effect (ΔIGF-I, p = 0.03) after all the adjustments. Specifically, for each unit of PA, ΔIGF-I increased by 9.7 (95% CI 1,1−18.4) ng/mL after full adjustment. This supports the notion that pre-stroke PA is independently related to ΔIGF-I.
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Affiliation(s)
- N. David Åberg
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden; (G.G.); (D.Å.); (J.S.); (J.I.)
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg SE-41345, Sweden;
- Correspondence: ; Tel.: +46-31-342-8422
| | - Gustaf Gadd
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden; (G.G.); (D.Å.); (J.S.); (J.I.)
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg SE-41345, Sweden;
| | - Daniel Åberg
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden; (G.G.); (D.Å.); (J.S.); (J.I.)
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg SE-41345, Sweden;
| | - Peter Hällgren
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg SE-41345, Sweden;
| | - Christian Blomstrand
- Department for Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden; (C.B.); (K.J.)
| | - Katarina Jood
- Department for Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden; (C.B.); (K.J.)
| | - Michael Nilsson
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, the University of Newcastle, University Dr, Callaghan, NSW 2308, Australia; (M.N.); (F.R.W.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Fredrick R. Walker
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, the University of Newcastle, University Dr, Callaghan, NSW 2308, Australia; (M.N.); (F.R.W.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden; (G.G.); (D.Å.); (J.S.); (J.I.)
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden;
- Department of Clinical genetics and genomics, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden
| | - Jörgen Isgaard
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, SE-41345 Gothenburg, Sweden; (G.G.); (D.Å.); (J.S.); (J.I.)
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, the University of Newcastle, University Dr, Callaghan, NSW 2308, Australia; (M.N.); (F.R.W.)
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Walser M, Svensson J, Karlsson L, Motalleb R, Åberg M, Kuhn HG, Isgaard J, Åberg ND. Growth Hormone and Neuronal Hemoglobin in the Brain-Roles in Neuroprotection and Neurodegenerative Diseases. Front Endocrinol (Lausanne) 2020; 11:606089. [PMID: 33488521 PMCID: PMC7821093 DOI: 10.3389/fendo.2020.606089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
In recent years, evidence for hemoglobin (Hb) synthesis in both animal and human brains has been accumulating. While circulating Hb originating from cerebral hemorrhage or other conditions is toxic, there is also substantial production of neuronal Hb, which is influenced by conditions such as ischemia and regulated by growth hormone (GH), insulin-like growth factor-I (IGF-I), and other growth factors. In this review, we discuss the possible functions of circulating and brain Hb, mainly the neuronal form, with respect to the neuroprotective activities of GH and IGF-I against ischemia and neurodegenerative diseases. The molecular pathways that link Hb to the GH/IGF-I system are also reviewed, although the limited number of reports on this topic suggests a need for further studies. In summary, GH and/or IGF-I appear to be significant determinants of systemic and local brain Hb concentrations through mediating responses to oxygen and metabolic demand, as part of the neuroprotective effects exerted by GH and IGF-I. The nature and quantity of the latter deserve further exploration in specific experiments.
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Affiliation(s)
- Marion Walser
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- *Correspondence: Marion Walser,
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Karlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Reza Motalleb
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- School of Public Health and Community Medicine at University of Gothenburg, Gothenburg, Sweden
| | - H Georg Kuhn
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Institute for Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jörgen Isgaard
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - N David Åberg
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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10
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Santi A, Genis L, Torres Aleman I. A Coordinated Action of Blood-Borne and Brain Insulin-Like Growth Factor I in the Response to Traumatic Brain Injury. Cereb Cortex 2019; 28:2007-2014. [PMID: 28449086 DOI: 10.1093/cercor/bhx106] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/11/2017] [Indexed: 01/20/2023] Open
Abstract
In response to injury, the brain produces different neuroprotective molecules, such as insulin-like growth factor I (IGF-I). However, IGF-I is also taken up by the brain from the circulation in response to physiological stimuli. Herein, we analyzed in mice the relative contribution of circulating and locally produced IGF-I to increased brain IGF-I levels after insult. Traumatic brain injury (TBI) induced by a controlled impact resulted in increased IGF-I levels in the vicinity of the lesion, but mice with low serum IGF-I showed significantly lower increases. Indeed, in normal mice, peripheral IGF-I accumulated at the lesion site after injury, and at the same time serum IGF-I levels decreased. Collectively, these data suggest that serum IGF-I enter into the brain after TBI and contributes to increased brain IGF-I levels at the injury site. This connection between central and circulating IGF-I provides an amenable route for treatment, as subcutaneous administration of IGF-I to TBI mice led to functional recovery. These latter results add further support to the use of systemic IGF-I or its mimetics for treatment of brain injuries.
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Affiliation(s)
- A Santi
- Cajal Institute, CSIC, Avda Dr Arce 37, 28002 Madrid, Spain.,Ciberned, C/ Valderrebollo 5, 28031 Madrid, Spain
| | - L Genis
- Cajal Institute, CSIC, Avda Dr Arce 37, 28002 Madrid, Spain.,Ciberned, C/ Valderrebollo 5, 28031 Madrid, Spain
| | - I Torres Aleman
- Cajal Institute, CSIC, Avda Dr Arce 37, 28002 Madrid, Spain.,Ciberned, C/ Valderrebollo 5, 28031 Madrid, Spain
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11
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Munakomi S. Preventing Muscle Atrophy Following Strokes: A Reappraisal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1088:593-601. [PMID: 30390272 DOI: 10.1007/978-981-13-1435-3_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Muscle atrophy leading to muscle weakness accounts for major cause of disabilities among stroke survivors. It amounts to compromised gait and prevails to viscous cycle of diminished physical capacities and compromised participation in rehabilitative tasks. There is predisposition to recurrent strokes due to added risk of developing metabolic syndrome. Therefore, beyond the shadow of doubt, there is ripple effect of rehabilitation and thereby muscle protection in these subsets of patients. Herein, we highlight upon the newer insights with regard to preventing muscle atrophy following strokes.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Teaching Hospital, Biratnagar, Nepal.
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12
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Chronic heat stress increases insulin-like growth factor-1(IGF-1) but does not affect IGF-binding proteins in growing pigs. J Therm Biol 2018; 77:122-130. [DOI: 10.1016/j.jtherbio.2018.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/08/2018] [Accepted: 08/17/2018] [Indexed: 12/19/2022]
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13
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Åberg ND, Åberg D, Jood K, Nilsson M, Blomstrand C, Kuhn HG, Svensson J, Jern C, Isgaard J. Altered levels of circulating insulin-like growth factor I (IGF-I) following ischemic stroke are associated with outcome - a prospective observational study. BMC Neurol 2018; 18:106. [PMID: 30081862 PMCID: PMC6091156 DOI: 10.1186/s12883-018-1107-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/22/2018] [Indexed: 01/12/2023] Open
Abstract
Background Insulin-like growth factor I (IGF-I) has neuroprotective effects in experimental ischemic stroke (IS). However, in patients who have suffered IS, various associations between the levels of serum IGF-I (s-IGF-I) and clinical outcome have been reported, probably reflecting differences in sampling time-points and follow-up periods. Since changes in the levels of post-stroke s-IGF-I have not been extensively explored, we investigated whether decreases in the levels of s-IGF-I between the acute time-point (median, 4 days) and 3 months (ΔIGF-I, further transformed into ΔIGF-I-quintiles, ΔIGF-I-q) are associated with IS severity and outcome. Methods In the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) conducted in Gothenburg, Sweden, patients with IS who had s-IGF-I measurements available were included (N = 354; 65% males; mean age, 55 years). Baseline stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and converted into NIHSS-quintiles (NIHSS-q). Outcomes were assessed using the modified Rankin Scale (mRS) at 3 months and 2 years. Results In general, the levels of s-IGF-I decreased (positive ΔIGF-I), except for those patients with the most severe NIHSS-q. After correction for sex and age, the 3rd ΔIGF-I-q showed the strongest association to mRS 0–2 [Odds Ratio (OR) 5.11, 95% confidence interval (CI) 2.18–11.9], and after 2 years, the 5th ΔIGF-I-q (OR 3.63, 95% CI 1.40–9.38) showed the strongest association to mRS 0–2. The associations remained significant after multivariate correction for diabetes, smoking, hypertension, and hyperlipidemia after 3 months, but were not significant (p = 0.057) after 2 years. The 3-month associations withstood additional correction for baseline stroke severity (p = 0.035), whereas the 2-year associations were further attenuated (p = 0.31). Conclusions Changes in the levels of s-IGF-I are associated primarily with temporally near 3-month outcomes, while associations with long-term 2-year outcomes are weakened and attenuated by other factors. The significance of the change in post-stroke s-IGF-I is compatible with a positive role for IGF-I in IS recovery. However, the exact mechanisms are unknown and probably reflects combinations of multiple peripheral and central actions. Electronic supplementary material The online version of this article (10.1186/s12883-018-1107-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N David Åberg
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.
| | - Daniel Åberg
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - H Georg Kuhn
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Christina Jern
- Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jörgen Isgaard
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
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14
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Gubbi S, Quipildor GF, Barzilai N, Huffman DM, Milman S. 40 YEARS of IGF1: IGF1: the Jekyll and Hyde of the aging brain. J Mol Endocrinol 2018; 61:T171-T185. [PMID: 29739805 PMCID: PMC5988994 DOI: 10.1530/jme-18-0093] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/30/2022]
Abstract
The insulin-like growth factor 1 (IGF1) signaling pathway has emerged as a major regulator of the aging process, from rodents to humans. However, given the pleiotropic actions of IGF1, its role in the aging brain remains complex and controversial. While IGF1 is clearly essential for normal development of the central nervous system, conflicting evidence has emerged from preclinical and human studies regarding its relationship to cognitive function, as well as cerebrovascular and neurodegenerative disorders. This review delves into the current state of the evidence examining the role of IGF1 in the aging brain, encompassing preclinical and clinical studies. A broad examination of the data indicates that IGF1 may indeed play opposing roles in the aging brain, depending on the underlying pathology and context. Some evidence suggests that in the setting of neurodegenerative diseases that manifest with abnormal protein deposition in the brain, such as Alzheimer's disease, reducing IGF1 signaling may serve a protective role by slowing disease progression and augmenting clearance of pathologic proteins to maintain cellular homeostasis. In contrast, inducing IGF1 deficiency has also been implicated in dysregulated function of cognition and the neurovascular system, suggesting that some IGF1 signaling may be necessary for normal brain function. Furthermore, states of acute neuronal injury, which necessitate growth, repair and survival signals to persevere, typically demonstrate salutary effects of IGF1 in that context. Appreciating the dual, at times opposing 'Dr Jekyll' and 'Mr Hyde' characteristics of IGF1 in the aging brain, will bring us closer to understanding its impact and devising more targeted IGF1-related interventions.
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Affiliation(s)
- Sriram Gubbi
- Institute for Aging ResearchAlbert Einstein College of Medicine, Bronx, New York, USA
- Department of Internal MedicineJacobi Medical Center, Bronx, New York, USA
| | - Gabriela Farias Quipildor
- Institute for Aging ResearchAlbert Einstein College of Medicine, Bronx, New York, USA
- Department of Molecular PharmacologyAlbert Einstein College of Medicine, Bronx, New York, USA
- Division of EndocrinologyDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nir Barzilai
- Institute for Aging ResearchAlbert Einstein College of Medicine, Bronx, New York, USA
- Division of EndocrinologyDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Division of GeriatricsDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of GeneticsAlbert Einstein College of Medicine, Bronx, New York, USA
| | - Derek M Huffman
- Institute for Aging ResearchAlbert Einstein College of Medicine, Bronx, New York, USA
- Department of Molecular PharmacologyAlbert Einstein College of Medicine, Bronx, New York, USA
- Division of EndocrinologyDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sofiya Milman
- Institute for Aging ResearchAlbert Einstein College of Medicine, Bronx, New York, USA
- Division of EndocrinologyDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Division of GeriatricsDepartment of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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15
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Zhang W, Wang W, Kuang L. The relation between insulin-like growth factor 1 levels and risk of depression in ischemic stroke. Int J Geriatr Psychiatry 2018; 33:e228-e233. [PMID: 28833493 DOI: 10.1002/gps.4774] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/13/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study is to evaluate whether lower serum levels of insulin-like growth factor 1 (IGF-1) in the acute phase of ischemic stroke are associated with higher risk of post-stroke depression (PSD) over a 1-year period. METHODS The subjects were first-ever acute ischemic stroke (AIS) patients who were hospitalized from July 1, 2014 to August 31, 2015. The study also included 120 age-matched and sex-matched healthy controls from the same geographical area. Fasting blood samples were collected within 24 hours of admission for IGF-I measurement. Neurological and neuropsychological evaluations were conducted at a 1-year follow-up. RESULTS Two-hundred twenty-five patients were observed for a 1-year follow-up, and 74 of these patients (32.9%, 95%CI: 26.8%-39.0%) were diagnosed with PSD. The depression distribution across the IGF-1 quartiles ranged between 61.4% (first quartile) and 8.9% (fourth quartile). In a multivariate model using the first quartiles of the IGF-1 versus quartiles 2 through 4, together with the significant clinical variables, the marker displayed prognostic information, and the odds ratio (OR) for first quartile was 3.35 [95% CI, 1.88-6.79; P = 0.001]. CONCLUSION The data showed that low serum IGF-1 levels at admission are associated with a high risk of developing PSD, suggesting that these alterations might be involved in the pathophysiology of depression symptoms in stroke patients.
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Affiliation(s)
- Wei Zhang
- Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kuang
- Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Four birds with one stone? Reparative, neuroplastic, cardiorespiratory, and metabolic benefits of aerobic exercise poststroke. Curr Opin Neurol 2018; 29:684-692. [PMID: 27661010 DOI: 10.1097/wco.0000000000000383] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Converging evidence from animal models of stroke and clinical trials suggests that aerobic exercise has effects across multiple targets. RECENT FINDINGS The subacute phase is characterized by a period of heightened neuroplasticity when aerobic exercise has the potential to optimize recovery. In animals, low intensity aerobic exercise shrinks lesion size and reduces cell death and inflammation, beginning 24 h poststroke. Also in animals, aerobic exercise upregulates brain-derived neurotrophic factor near the lesion and improves learning. In terms of neuroplastic effects, clinical trial results are less convincing and have only examined effects in chronic stroke. Stroke patients demonstrate cardiorespiratory fitness levels below the threshold required to carry out daily activities. This may contribute to a 'neurorehabilitation ceiling' that limits capacity to practice at a high enough frequency and intensity to promote recovery. Aerobic exercise when delivered 2-5 days per week at moderate to high intensity beginning as early as 5 days poststroke improves cardiorespiratory fitness, dyslipidemia, and glucose tolerance. SUMMARY Based on the evidence discussed and applying principles of periodization commonly used to prepare athletes for competition, we have created a model of aerobic training in subacute stroke in which training is delivered in density blocks (duration × intensity) matched to recovery phases.
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17
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Gandolfi M, Smania N, Vella A, Picelli A, Chirumbolo S. Assessed and Emerging Biomarkers in Stroke and Training-Mediated Stroke Recovery: State of the Art. Neural Plast 2017; 2017:1389475. [PMID: 28373915 PMCID: PMC5360976 DOI: 10.1155/2017/1389475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/11/2017] [Indexed: 12/13/2022] Open
Abstract
Since the increasing update of the biomolecular scientific literature, biomarkers in stroke have reached an outstanding and remarkable revision in the very recent years. Besides the diagnostic and prognostic role of some inflammatory markers, many further molecules and biological factors have been added to the list, including tissue derived cytokines, growth factor-like molecules, hormones, and microRNAs. The literatures on brain derived growth factor and other neuroimmune mediators, bone-skeletal muscle biomarkers, cellular and immunity biomarkers, and the role of microRNAs in stroke recovery were reviewed. To date, biomarkers represent a possible challenge in the diagnostic and prognostic evaluation of stroke onset, pathogenesis, and recovery. Many molecules are still under investigation and may become promising and encouraging biomarkers. Experimental and clinical research should increase this list and promote new discoveries in this field, to improve stroke diagnosis and treatment.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Antonio Vella
- Immunology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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