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Yin J, Wang S, Wang J, Zhang Y, Fan C, Chao J, Gao Y, Wang L. An intelligent DNA nanodevice for precision thrombolysis. NATURE MATERIALS 2024; 23:854-862. [PMID: 38448659 DOI: 10.1038/s41563-024-01826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Thrombosis is a leading global cause of death, in part due to the low efficacy of thrombolytic therapy. Here, we describe a method for precise delivery and accurate dosing of tissue plasminogen activator (tPA) using an intelligent DNA nanodevice. We use DNA origami to integrate DNA nanosheets with predesigned tPA binding sites and thrombin-responsive DNA fasteners. The fastener is an interlocking DNA triplex structure that acts as a thrombin recognizer, threshold controller and opening switch. When loaded with tPA and intravenously administrated in vivo, these DNA nanodevices rapidly target the site of thrombosis, track the circulating microemboli and expose the active tPA only when the concentration of thrombin exceeds a threshold. We demonstrate their improved therapeutic efficacy in ischaemic stroke and pulmonary embolism models, supporting the potential of these nanodevices to provide accurate tPA dosing for the treatment of different thromboses.
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Affiliation(s)
- Jue Yin
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Siyu Wang
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jiahui Wang
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chunhai Fan
- School of Chemistry and Chemical Engineering, New Cornerstone Science Laboratory, Frontiers Science Center for Transformative Molecules, Zhangjiang Institute for Advanced Study and National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acids Chemistry and Nanomedicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Chao
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China.
| | - Yu Gao
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China.
| | - Lianhui Wang
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, Nanjing, China.
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Wang G, Li Z, Wang G, Sun Q, Lin P, Wang Q, Zhang H, Wang Y, Zhang T, Cui F, Zhong Z. Advances in Engineered Nanoparticles for the Treatment of Ischemic Stroke by Enhancing Angiogenesis. Int J Nanomedicine 2024; 19:4377-4409. [PMID: 38774029 PMCID: PMC11108071 DOI: 10.2147/ijn.s463333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/02/2024] [Indexed: 05/24/2024] Open
Abstract
Angiogenesis, or the formation of new blood vessels, is a natural defensive mechanism that aids in the restoration of oxygen and nutrition delivery to injured brain tissue after an ischemic stroke. Angiogenesis, by increasing vessel development, may maintain brain perfusion, enabling neuronal survival, brain plasticity, and neurologic recovery. Induction of angiogenesis and the formation of new vessels aid in neurorepair processes such as neurogenesis and synaptogenesis. Advanced nano drug delivery systems hold promise for treatment stroke by facilitating efficient transportation across the the blood-brain barrier and maintaining optimal drug concentrations. Nanoparticle has recently been shown to greatly boost angiogenesis and decrease vascular permeability, as well as improve neuroplasticity and neurological recovery after ischemic stroke. We describe current breakthroughs in the development of nanoparticle-based treatments for better angiogenesis therapy for ischemic stroke employing polymeric nanoparticles, liposomes, inorganic nanoparticles, and biomimetic nanoparticles in this study. We outline new nanoparticles in detail, review the hurdles and strategies for conveying nanoparticle to lesions, and demonstrate the most recent advances in nanoparticle in angiogenesis for stroke treatment.
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Affiliation(s)
- Guangtian Wang
- Teaching Center of Pathogenic Biology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
- Department of Microbiology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Zhihui Li
- Department of Neurology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People’s Republic of China
| | - Gongchen Wang
- Department of Vascular Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People’s Republic of China
| | - Qixu Sun
- Department of Gastroenterology, Penglai People’s Hospital, Yantai, Shandong, 265600, People’s Republic of China
| | - Peng Lin
- Teaching Center of Pathogenic Biology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Qian Wang
- Department of Microbiology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Huishu Zhang
- Teaching Center of Biotechnology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Yanyan Wang
- Teaching Center of Morphology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Tongshuai Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Feiyun Cui
- Department of Physiology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
| | - Zhaohua Zhong
- Teaching Center of Pathogenic Biology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
- Department of Microbiology, School of Basic Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, 150081, People’s Republic of China
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Hao C, Sha M, Ye Y, Wang C. Cell Membrane-Derived Nanovehicles for Targeted Therapy of Ischemic Stroke: From Construction to Application. Pharmaceutics 2023; 16:6. [PMID: 38276484 PMCID: PMC10819970 DOI: 10.3390/pharmaceutics16010006] [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: 10/16/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 01/27/2024] Open
Abstract
Ischemic stroke (IS) is a prevalent form of stroke and a leading cause of mortality and disability. Recently, cell membrane-derived nanovehicles (CMNVs) derived from erythrocytes, thrombocytes, neutrophils, macrophages, neural stem cells, and cancer cells have shown great promise as drug delivery systems for IS treatment. By precisely controlling drug release rates and targeting specific sites in the brain, CMNVs enable the reduction in drug dosage and minimization of side effects, thus significantly enhancing therapeutic strategies and approaches for IS. While there are some reviews regarding the applications of CMNVs in the treatment of IS, there has been limited attention given to important aspects such as carrier construction, structural design, and functional modification. Therefore, this review aims to address these key issues in CMNVs preparation, structural composition, modification, and other relevant aspects, with a specific focus on targeted therapy for IS. Finally, the challenges and prospects in this field are discussed.
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Affiliation(s)
- Cui Hao
- School of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China; (H.C.); (S.M.); (Y.Y.)
| | - Ma Sha
- School of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China; (H.C.); (S.M.); (Y.Y.)
| | - Yang Ye
- School of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China; (H.C.); (S.M.); (Y.Y.)
- Key Laboratory of Sustainable Utilization of Panax Notoginseng Resources of Yunnan Province, Kunming 650500, China
| | - Chengxiao Wang
- School of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China; (H.C.); (S.M.); (Y.Y.)
- Key Laboratory of Sustainable Utilization of Panax Notoginseng Resources of Yunnan Province, Kunming 650500, China
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Chen W, Jiang B, Zhao Y, Yu W, Zhang M, Liang Z, Liu X, Ye B, Chen D, Yang L, Li F. Discovery of benzyloxy benzamide derivatives as potent neuroprotective agents against ischemic stroke. Eur J Med Chem 2023; 261:115871. [PMID: 37852031 DOI: 10.1016/j.ejmech.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
Aberrant activation of N-methyl-d-aspartate receptors (NMDAR) and the resulting neuronal nitric oxide synthase (nNOS) excessive activation play crucial pathogenic roles in neuronal damage caused by stroke. Disrupting postsynaptic density protein 95 (PSD95)-nNOS protein-protein interaction (PPI) has been proposed as a potential therapeutic strategy for ischemic stroke without incurring the unwanted side effects of direct NMDAR antagonism. Based on a specific PSD95-nNOS PPI inhibitor (SCR4026), we conducted a detailed study on structure-activity relationship (SAR) to discover a series of novel benzyloxy benzamide derivatives. Here, our efforts resulted in the best 29 (LY836) with improved neuroprotective activities in primary cortical neurons from glutamate-induced damage and drug-like properties. Whereafter, co-immunoprecipitation experiment demonstrated that 29 significantly blocked PSD95-nNOS association in cultured cortical neurons. Furthermore, 29 displayed good pharmacokinetic properties (T1/2 = 4.26 and 4.08 h after oral and intravenous administration, respectively) and exhibited powerful therapeutic effects in rats subjected to middle cerebral artery occlusion (MCAO) by reducing infarct size and neurological deficit score. These findings suggested that compound 29 may be a promising neuroprotection agent for the treatment of ischemic stroke.
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Affiliation(s)
- Weilin Chen
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China; Department of Medicinal Chemistry, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Bo Jiang
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Yifan Zhao
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Wei Yu
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Minyue Zhang
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Zhenchu Liang
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Xing Liu
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Binglin Ye
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Dongyin Chen
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China; Department of Medicinal Chemistry, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
| | - Lei Yang
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
| | - Fei Li
- Key Laboratory of Cardiovascular & Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China; Department of Medicinal Chemistry, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
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Liu Z, Xia Q, Ma D, Wang Z, Li L, Han M, Yin X, Ji X, Wang S, Xin T. Biomimetic nanoparticles in ischemic stroke therapy. DISCOVER NANO 2023; 18:40. [PMID: 36969494 PMCID: PMC10027986 DOI: 10.1186/s11671-023-03824-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/07/2023] [Indexed: 05/28/2023]
Abstract
Abstract Ischemic stroke is one of the most severe neurological disorders with limited therapeutic strategies. The utilization of nanoparticle drug delivery systems is a burgeoning field and has been widely investigated. Among these, biomimetic drug delivery systems composed of biogenic membrane components and synthetic nanoparticles have been extensively highlighted in recent years. Biomimetic membrane camouflage presents an effective strategy to prolong circulation, reduce immunogenicity and enhance targeting. For one thing, biomimetic nanoparticles reserve the physical and chemical properties of intrinsic nanoparticle. For another, the biological functions of original source cells are completely inherited. Compared to conventional surface modification methods, this approach is more convenient and biocompatible. In this review, membrane-based nanoparticles derived from different donor cells were exemplified. The prospect of future biomimetic nanoparticles in ischemic stroke therapy was discussed. Graphic abstract
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Affiliation(s)
- Zihao Liu
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021 China
| | - Qian Xia
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 China
| | - Dengzhen Ma
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021 China
| | - Zhihai Wang
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250021 China
| | - Longji Li
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250021 China
| | - Min Han
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014 China
| | - Xianyong Yin
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014 China
| | - Xiaoshuai Ji
- Department of Neurosurgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021 China
| | - Shan Wang
- Shandong Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Tao Xin
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250021 China
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014 China
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117 China
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Yang L, Huang X, Wang J, Yang X, Ding L, Li Z, Li J. Identifying stroke-related quantified evidence from electronic health records in real-world studies. Artif Intell Med 2023; 140:102552. [PMID: 37210153 DOI: 10.1016/j.artmed.2023.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Stroke is one of the leading causes of death and disability worldwide. The National Institutes of Health Stroke Scale (NIHSS) scores in electronic health records (EHRs), which quantitatively describe patients' neurological deficits in evidence-based treatment, are crucial in stroke-related clinical investigations. However, the free-text format and lack of standardization inhibit their effective use. Automatically extracting the scale scores from the clinical free text so that its potential value in real-world studies is realized has become an important goal. OBJECTIVE This study aims to develop an automated method to extract scale scores from the free text of EHRs. METHODS We propose a two-step pipeline method to identify NIHSS items and numerical scores and validate its feasibility using a freely accessible critical care database: MIMIC-III (Medical Information Mart for Intensive Care III). First, we utilize MIMIC-III to create an annotated corpus. Then, we investigate possible machine learning methods for two subtasks, NIHSS item and score recognition and item-score relation extraction. In the evaluation, we conduct both task-specific and end-to-end evaluations and compare our method with the rule-based method using precision, recall and F1 scores as evaluation metrics. RESULTS We use all available discharge summaries of stroke cases in MIMIC-III. The annotated NIHSS corpus contains 312 cases, 2929 scale items, 2774 scores and 2733 relations. The results show that the best F1-score of our method was 0.9006, which was attained by combining BERT-BiLSTM-CRF and Random Forest, and it outperformed the rule-based method (F1-score = 0.8098). In the end-to-end task, our method could successfully recognize the item "1b level of consciousness questions", the score "1" and their relation "('1b level of consciousness questions', '1', 'has value')" from the sentence "1b level of consciousness questions: said name = 1", while the rule-based method could not. CONCLUSIONS The two-step pipeline method we propose is an effective approach to identify NIHSS items, scores and their relations. With its help, clinical investigators can easily retrieve and access structured scale data, thereby supporting stroke-related real-world studies.
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Affiliation(s)
- Lin Yang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China; Key Laboratory of Medical Information Intelligent Technology, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Xiaoshuo Huang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China; School of Health Care Technology, Dalian Neusoft University of Information, Dalian 116023, China
| | - Jiayang Wang
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lingling Ding
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiao Li
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100020, China; Key Laboratory of Medical Information Intelligent Technology, Chinese Academy of Medical Sciences, Beijing 100020, China.
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Chen YL, Chen YC, Xiong LA, Huang QY, Gong TT, Chen Y, Ma LF, Fang L, Zhan ZJ. Discovery of phenylcarbamoyl xanthone derivatives as potent neuroprotective agents for treating ischemic stroke. Eur J Med Chem 2023; 251:115251. [PMID: 36921528 DOI: 10.1016/j.ejmech.2023.115251] [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: 01/19/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Compounds of natural sources are widespread discovered in the treatment of ischemic stroke. Alpha-mangostin, a natural prenylated xanthone, has been found to display a therapeutic potential to treat ischemic stroke. However, the direct application of α-mangostin is limited due to its cytotoxicity and relatively low efficacy. Herein, structural modification of α-mangostin was necessary to improve its drug-ability. Currently, 34 α-mangostin phenylcarbamoyl derivatives were synthesized and evaluated for their neuroprotective activities by glutamate-induced excitotoxicity and H2O2-induced oxidative damage models in vitro. The results showed that compound 2 had the most therapeutic potential in both models. Whereafter, 2 has been proved to have powerful therapeutic effects by the MCAO ischemic stroke model in rats, which might be due to inhibition of inflammatory reaction and free radical accumulation. Besides, acute toxicity assay in rats showed that compound 2 had excellent safety. Overall, 2 could be a promising neuroprotective agent for the treatment of ischemic stroke deserving further investigations.
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Affiliation(s)
- Yi-Li Chen
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Yu-Chen Chen
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Lin-An Xiong
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Qu-Yang Huang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Ting-Ting Gong
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Yan Chen
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Lie-Feng Ma
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China
| | - Luo Fang
- Department of Pharmacy, Zhejiang Cancer Hospital, PR China.
| | - Zha-Jun Zhan
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, PR China.
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Fukuta T, Oku N, Kogure K. Application and Utility of Liposomal Neuroprotective Agents and Biomimetic Nanoparticles for the Treatment of Ischemic Stroke. Pharmaceutics 2022; 14:pharmaceutics14020361. [PMID: 35214092 PMCID: PMC8877231 DOI: 10.3390/pharmaceutics14020361] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
Ischemic stroke is still one of the leading causes of high mortality and severe disability worldwide. Therapeutic options for ischemic stroke and subsequent cerebral ischemia/reperfusion injury remain limited due to challenges associated with drug permeability through the blood-brain barrier (BBB). Neuroprotectant delivery with nanoparticles, including liposomes, offers a promising solution to address this problem, as BBB disruption following ischemic stroke allows nanoparticles to pass through the intercellular gaps between endothelial cells. To ameliorate ischemic brain damage, a number of nanotherapeutics encapsulating neuroprotective agents, as well as surface-modified nanoparticles with specific ligands targeting the injured brain regions, have been developed. Combination therapy with nanoparticles encapsulating neuroprotectants and tissue plasminogen activator (t-PA), a globally approved thrombolytic agent, has been demonstrated to extend the narrow therapeutic time window of t-PA. In addition, the design of biomimetic drug delivery systems (DDS) employing circulating cells (e.g., leukocytes, platelets) with unique properties has recently been investigated to overcome the injured BBB, utilizing these cells’ inherent capability to penetrate the ischemic brain. Herein, we review recent findings on the application and utility of nanoparticle DDS, particularly liposomes, and various approaches to developing biomimetic DDS functionalized with cellular membranes/membrane proteins for the treatment of ischemic stroke.
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Affiliation(s)
- Tatsuya Fukuta
- Department of Physical Pharmaceutics, School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Shichiban-cho, Wakayama 640-8156, Japan
| | - Naoto Oku
- Faculty of Pharma-Science, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
- Department of Medical Biochemistry, School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
| | - Kentaro Kogure
- Department of Pharmaceutical Health Chemistry, Graduate School of Biomedical Sciences, Tokushima University, Shomachi 1, Tokushima 770-8505, Japan
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He W, Zhang Z, Sha X. Nanoparticles-mediated emerging approaches for effective treatment of ischemic stroke. Biomaterials 2021; 277:121111. [PMID: 34488117 DOI: 10.1016/j.biomaterials.2021.121111] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
Ischemic stroke leads to high disability and mortality. The limited delivery efficiency of most therapeutic substances is a major challenge for effective treatment of ischemic stroke. Inspired by the prominent merit of nanoscale particles in brain targeting and blood-brain barrier (BBB) penetration, various functional nanoparticles have been designed as promising drug delivery platforms that are expected to improve the therapeutic effect of ischemic stroke. Based on the complex pathological mechanisms of ischemic stroke, this review outline and summarize the rationally designed nanoparticles-mediated emerging approaches for effective treatment of ischemic stroke, including recanalization therapy, neuroprotection therapy, and combination therapy. On this bases, the potentials and challenges of nanoparticles in the treatment of ischemic stroke are revealed, and new thoughts and perspectives are proposed for the design of feasible nanoparticles for effective treatment of ischemic stroke.
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Affiliation(s)
- Wenxiu He
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Zhiwen Zhang
- State Key Laboratory of Drug Research & Center of Pharmaceutics, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Xianyi Sha
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University, Shanghai, 201203, China; The Institutes of Integrative Medicine of Fudan University, 120 Urumqi Middle Road, Shanghai, 200040, China.
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Ni LY, Tang JY. Clinical safety and outcome of recombinant tissue plasminogen activator in patients with stroke attributable to small artery occlusion: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26453. [PMID: 34160442 PMCID: PMC8238356 DOI: 10.1097/md.0000000000026453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recent observations raised concern that the intravenous recombinant tissue plasminogen activator (rt-PA) may result in damage to stroke patients caused by small artery occlusion (SAO). Thus, we perform a protocol for meta-analysis to investigate the efficacy and safety of intravenous thrombolysis with rt-PA in SAO-patients. METHODS The search-style electronic libraries, including Pubmed, Embase, the Cochrane Library, Web of Science, Wanfang Data, VIP Chinese Journals, and China Biomedical Literature Service System are used for document retrieval in June 2021 with no restrictions on language. The risk of bias in include articles will be assessed using the Cochrane Risk of Bias Tool. We perform the meta-analysis by Stata version 10.0 software and calculated the statistics using the inverse variance statistical method. Binary outcomes are presented as Mantel-Haenszel-style risk ratios with 95% confidence interval. Continuous outcomes are reported as mean differences. RESULTS The results of the article will be shown in a peer-reviewed journal. CONCLUSION Intravenous rt-PA may be effective and safe in SAO-patients.
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Affiliation(s)
- Li-Yan Ni
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University
- Department of Neurology, Juye County People's Hospital, Shandong, People's Republic of China
| | - Ji-You Tang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University
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Xu M, Guo J, Tao X, Zeng K. The Efficacy and Safety of Intravenous Thrombolysis in Older Chinese Patients with Acute Ischemic Stroke. Neurol India 2021; 69:91-96. [PMID: 33642277 DOI: 10.4103/0028-3886.310086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To study the efficacy and safety of intravenous thrombolysis for the older acute ischemic stroke patients, clinical data were prospectively analyzed from 168 patients with acute ischemic stroke including 42 older adult patients (ET group), 66 younger patients (NET group) treated with rt-PA, and 60 older adult patients treated without rt-PA (ENT group). Stroke severity was assessed with an NIHSS score at baseline, 1-day and 14-day after treatment. Functional outcomes were evaluated by the modified Rankin scale and a Barthel index. Adverse effects were observed during the treatment. The rate of "good" prognosis was higher in the ET group than that in the ENT group at 90 days post-stroke. In older patients with stroke, thrombolytic therapy was found to be of greater benefit to patients with lower NIHSS scores at baseline, or patients classified as posterior circulation infarction, than for patients with higher NIHSS scores or infarctions located in other brain regions. Thrombolytic therapy may exhibit long-term efficacy by improving the future quality of life for older stroke patients with fewer bleeding risk factors and lower baseline NIHSS scores.
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Affiliation(s)
- Ming Xu
- Department of Neurology, First Affliated Hospital of Chongqing Medical University; Department of Neurology, Dazu Hospital, Chongqing, China
| | - Jiamei Guo
- Department of Neurology, First Affliated Hospital of Chongqing Medical University; Psychiatry, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xianming Tao
- Department of Neurology, First Affliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kebin Zeng
- Department of Neurology, First Affliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Transdermal System Based on Solid Cilostazol Nanoparticles Attenuates Ischemia/Reperfusion-Induced Brain Injury in Mice. NANOMATERIALS 2021; 11:nano11041009. [PMID: 33920878 PMCID: PMC8071240 DOI: 10.3390/nano11041009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Cilostazol (CIL) exerted a protective effect by promoting blood-brain barrier integrity as well as improving the status of neurological dysfunctions following cerebral ischemia/reperfusion (I/R) injury. We attempted to design a 0.5% CIL carbopol gel using solid nanoparticles (CIL-Ngel), and then investigated the relationships between energy-dependent endocytosis and the skin penetration of CIL-Ngel in this study. In addition, we evaluated whether the CIL-Ngel attenuated I/R-induced brain injury in a middle cerebral artery occlusion (MCAO)/reperfusion model mouse. The particle size of CIL was decreased using a bead mill, and the CIL particles (14.9 × 1014 particles/0.3 g) in the CIL-Ngel were approximately 50-180 nm. The release of CIL in the CIL-Ngel was higher than that in gel containing CIL powder (CIL-Mgel), and the CIL particles were released from the CIL-Ngel as nanoparticles. In addition, the percutaneous absorption of CIL from the CIL-Ngel was higher in comparison with that from CIL-Mgel, and clathrin-dependent endocytosis and caveolae-dependent endocytosis were related to the enhanced skin penetration of CIL-NPs. In the traditional (oral administration of CIL powder, 3 mg/kg) and transdermal administration (CIL-Ngel, 0.3 g) for 3 days (once a day), the area under the plasma CIL concentration-time curves (AUC) was similar, although the CIL supplied to the blood by the CIL-Ngel was more sustained than that via oral administration of CIL powder. Furthermore, the CIL-Ngel attenuated the ischemic stroke. In conclusion, we designed a gel using solid CIL-NPs, and we showed that the sustained release of CIL by CIL-Ngel provided an effective treatment for ischemic stroke in MCAO/reperfusion model mice. These findings induce the possibilities of developing novel applications of CIL solid nanoparticles.
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Singh V, Shri R, Krishan P, Singh IP, Shah P. Isolation and characterization of components responsible for neuroprotective effects of Allium cepa outer scale extract against ischemia reperfusion induced cerebral injury in mice. J Food Sci 2020; 85:4009-4017. [PMID: 33051874 DOI: 10.1111/1750-3841.15474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
The antioxidant-mediated neuroprotective effect of Allium cepa outer scale extract (ACE) in mice with cerebral ischemia-reperfusion (I-R) injury was demonstrated in our earlier work. The current investigation aimed at establishing the bioactive component(s) responsible for this activity. Thus ACE was fractionated into ethyl acetate (EF) and aqueous (AF) fractions. These fractions were evaluated against cerebral I-R injury in mice. I-R injury in mice was induced by bilateral common carotid artery occlusion followed by 24 hr reperfusion. Memory, sensorimotor functions, cerebral infarct size, and oxidative stress were measured to address the neuroprotective mechanism of test substances. EF showed marked improvement of memory and sensorimotor functions by reducing brain oxidative stress and infarct size in mice after I-R injury. The bioactive EF was subjected to chromatographic (HPLC-PDA, HPLC-MS, preparative HPLC) and spectroscopic studies to isolate and identify the neuroprotective compounds. This lead to separation of three components, namely quercetin, quercetin 4'-O-glucoside, and the remaining fraction, from EF. The separated components were biologically evaluated. These components showed improvement in mice with I-R injury. But, EF displayed more marked neuroprotective effects as compared to the isolated components. The distinct neuroprotective outcome of EF may be credited to the synergistic action of compounds present in EF. Further studies such as evaluation of neurotoxic effects and other possible neuroprotective mechanisms are required to develop EF as a neuroprotective drug.
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Affiliation(s)
- Varinder Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, India.,Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Richa Shri
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, India
| | - Pawan Krishan
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University Patiala, India
| | - Inder Pal Singh
- Natural Products Research Laboratory, Department of Natural Products, National Institute of Pharmaceutical Education and Research, SAS Nagar, India
| | - Purvi Shah
- Natural Products Research Laboratory, Department of Natural Products, National Institute of Pharmaceutical Education and Research, SAS Nagar, India
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The neuroprotective action of 3,3'-diindolylmethane against ischemia involves an inhibition of apoptosis and autophagy that depends on HDAC and AhR/CYP1A1 but not ERα/CYP19A1 signaling. Apoptosis 2020; 24:435-452. [PMID: 30778709 PMCID: PMC6522467 DOI: 10.1007/s10495-019-01522-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are no studies examining the effects of 3,3′-diindolylmethane (DIM) in neuronal cells subjected to ischemia. Little is also known about the roles of apoptosis and autophagy as well as AhR and ERα signaling and HDACs in DIM action. We demonstrated for the first time the strong neuroprotective capacity of DIM in mouse primary hippocampal cell cultures exposed to ischemia at early and later stages of neuronal development. The protective effects of DIM were mediated via inhibition of ischemia-induced apoptosis and autophagy that was accompanied by a decrease in AhR/CYP1A1 signaling and an increase in HDAC activity. DIM decreased the levels of pro-apoptotic factors, i.e., Fas, Caspase-3, and p38 mitogen-activated protein kinase (MAPK). DIM also reduced the protein levels of autophagy-related Beclin-1 (BECN1) and microtubule-associated proteins 1A/1B light chain (LC3), partially reversed the ischemia-induced decrease in Nucleoporin 62 (NUP62) and inhibited autophagosome formation. In addition, DIM completely reversed the ischemia-induced decrease in histone deacetylase (HDAC) activity in hippocampal neurons. Although DIM inhibited AhR/CYP1A1 signaling, it did not influence the protein expression levels of ERα and ERα-regulated CYP19A1 which are known to be controlled by AhR. This study demonstrated for the first time, that the neuroprotective action of 3,3′-diindolylmethane against ischemia involves an inhibition of apoptosis and autophagy and depends on AhR/CYP1A1 signaling and HDAC activity, thus creating the possibility of developing new therapeutic strategies that target neuronal degeneration at specific molecular levels.
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Tseng YJ, Hu RF, Lee ST, Lin YL, Hsu CL, Lin SW, Liou CW, Lee JD, Peng TI, Lee TH. Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020618. [PMID: 31963654 PMCID: PMC7014350 DOI: 10.3390/ijerph17020618] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 12/26/2022]
Abstract
Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.
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Affiliation(s)
- Yi-Ju Tseng
- Department of Information Management, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.T.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ru-Fang Hu
- Department of Information Management, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.T.)
| | - Shin-Tyng Lee
- Department of Information Management, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.T.)
| | - Yu-Li Lin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33302, Taiwan
| | - Chien-Lung Hsu
- Department of Information Management, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.T.)
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Business and Management, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Visual Communication Design, Ming-Chi University of Technology, New Taipei City 24301, Taiwan
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shih-Wei Lin
- Department of Information Management, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.T.)
- Department of Industrial Engineering and Management, Ming-Chi University of Technology, New Taipei City 24301, Taiwan
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jiann-Der Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Tsung-I Peng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8340)
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Piccardi B, Biagini S, Iovene V, Palumbo V. Blood Biomarkers of Parenchymal Damage in Ischemic Stroke Patients Treated With Revascularization Therapies. Biomark Insights 2019; 14:1177271919888225. [PMID: 31903021 PMCID: PMC6931146 DOI: 10.1177/1177271919888225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Postischemic reperfusion injury may exacerbate cerebral damage and capillary dysfunction, leading to brain edema (BE), hemorrhagic transformation (HT), necrosis, and injury from free radicals with subsequent infarct growth (IG). Several plasmatic biomarkers involved in the ischemic cascade have been studied in relation to radiological and clinical outcomes of reperfusion injury in ischemic stroke with heterogeneous results. This article provides a brief overview of the contribution of circulating biomarkers to the pathophysiology of parenchymal damage in ischemic stroke patients treated with revascularization therapies. Methods We included full reports with measurements of plasma markers in patients with acute ischemic stroke treated with revascularization therapies. Findings Our research included a large number of observational studies investigating a possible role of circulating biomarkers in the development of parenchymal damage after acute stroke treatments. To make the results clearer, we divided the review in 4 sections, exploring the relation of different biomarkers with each of the indicators of parenchymal damage (HT, BE, IG, recanalization). Discussion and conclusion Definite conclusions are difficult to draw because of heterogeneity across studies. However, our review seems to confirm an association between some circulating biomarkers (particularly matrix metalloproteinase-9) and occurrence of parenchymal damage in ischemic stroke patients treated with revascularization therapies.
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Affiliation(s)
- Benedetta Piccardi
- Benedetta Piccardi, Stroke Unit, Careggi
University Hospital, Largo Brambilla, 3, 50134 Florence, Italy.
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Colasuonno M, Palange AL, Aid R, Ferreira M, Mollica H, Palomba R, Emdin M, Del Sette M, Chauvierre C, Letourneur D, Decuzzi P. Erythrocyte-Inspired Discoidal Polymeric Nanoconstructs Carrying Tissue Plasminogen Activator for the Enhanced Lysis of Blood Clots. ACS NANO 2018; 12:12224-12237. [PMID: 30427660 DOI: 10.1021/acsnano.8b06021] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Tissue plasminogen activator (tPA) is the sole approved therapeutic molecule for the treatment of acute ischemic stroke. Yet, only a small percentage of patients could benefit from this life-saving treatment because of medical contraindications and severe side effects, including brain hemorrhage, associated with delayed administration. Here, a nano therapeutic agent is realized by directly associating the clinical formulation of tPA to the porous structure of soft discoidal polymeric nanoconstructs (tPA-DPNs). The porous matrix of DPNs protects tPA from rapid degradation, allowing tPA-DPNs to preserve over 70% of the tPA original activity after 3 h of exposure to serum proteins. Under dynamic conditions, tPA-DPNs dissolve clots more efficiently than free tPA, as demonstrated in a microfluidic chip where clots are formed mimicking in vivo conditions. At 60 min post-treatment initiation, the clot area reduces by half (57 ± 8%) with tPA-DPNs, whereas a similar result (56 ± 21%) is obtained only after 90 min for free tPA. In murine mesentery venules, the intravenous administration of 2.5 mg/kg of tPA-DPNs resolves almost 90% of the blood clots, whereas a similar dose of free tPA successfully recanalizes only about 40% of the treated vessels. At about 1/10 of the clinical dose (1.0 mg/kg), tPA-DPNs still effectively dissolve 70% of the clots, whereas free tPA works efficiently only on 16% of the vessels. In vivo, discoidal tPA-DPNs outperform the lytic activity of 200 nm spherical tPA-coated nanoconstructs in terms of both percentage of successful recanalization events and clot area reduction. The conjugation of tPA with preserved lytic activity, the deformability and blood circulating time of DPNs together with the faster blood clot dissolution would make tPA-DPNs a promising nanotool for enhancing both potency and safety of thrombolytic therapies.
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Affiliation(s)
- Marianna Colasuonno
- Sant'Anna School of Advanced Studies , Piazza Martiri della Libertà, 33 , 56127 Pisa , Italy
- Laboratory of Nanotechnology for Precision Medicine , Fondazione Istituto Italiano di Tecnologia , Via Morego, 30 , 16163 Genoa , Italy
| | - Anna Lisa Palange
- Laboratory of Nanotechnology for Precision Medicine , Fondazione Istituto Italiano di Tecnologia , Via Morego, 30 , 16163 Genoa , Italy
| | - Rachida Aid
- INSERM U1148 - Laboratory for Vascular Translational Science, University Paris 13 , University Paris Diderot, X. Bichat Hospital , 46 rue Henri Huchard , 75018 Paris , France
| | - Miguel Ferreira
- Laboratory of Nanotechnology for Precision Medicine , Fondazione Istituto Italiano di Tecnologia , Via Morego, 30 , 16163 Genoa , Italy
| | - Hilaria Mollica
- Department of Informatics, Bioengineering, Robotics, and System Engineering , University of Genoa , Via Opera Pia, 13 , 16145 Genoa , Italy
- Laboratory of Nanotechnology for Precision Medicine , Fondazione Istituto Italiano di Tecnologia , Via Morego, 30 , 16163 Genoa , Italy
| | - Roberto Palomba
- Laboratory of Nanotechnology for Precision Medicine , Fondazione Istituto Italiano di Tecnologia , Via Morego, 30 , 16163 Genoa , Italy
| | - Michele Emdin
- Sant'Anna School of Advanced Studies , Piazza Martiri della Libertà, 33 , 56127 Pisa , Italy
- Fondazione Toscana G. Monasterio , Via G. Moruzzi, 1 , 56124 Pisa , Italy
| | - Massimo Del Sette
- S.C. Neurologia , E.O. Ospedali Galliera , Mura delle Cappuccine, 14 , 16128 Genova , Italy
| | - Cédric Chauvierre
- INSERM U1148 - Laboratory for Vascular Translational Science, University Paris 13 , University Paris Diderot, X. Bichat Hospital , 46 rue Henri Huchard , 75018 Paris , France
| | - Didier Letourneur
- INSERM U1148 - Laboratory for Vascular Translational Science, University Paris 13 , University Paris Diderot, X. Bichat Hospital , 46 rue Henri Huchard , 75018 Paris , France
| | - Paolo Decuzzi
- Laboratory of Nanotechnology for Precision Medicine , Fondazione Istituto Italiano di Tecnologia , Via Morego, 30 , 16163 Genoa , Italy
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Çetiner M, Aydin HE, Güler M, Canbaz Kabay S, Zorlu Y. Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke. Clin Appl Thromb Hemost 2018; 24:171S-177S. [PMID: 30213193 PMCID: PMC6714831 DOI: 10.1177/1076029618796317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The objective of our study is to detect the patient group that will most benefit
from intravenous (IV) thrombolytic therapy by showing predictive factors of good
functional outcomes. The present study covers 88 patients who were admitted to
our clinic within the first 4.5 hours from the onset of stroke symptoms,
diagnosed with acute ischemic stroke and who received IV thrombolytic therapy
between May 2014 and June 2017 as a result of a retrospective analysis of a
database prospectively collected. The patients with a score of ≤2 on modified
Rankin scale within 3 months were accepted as good functional outcome and those
with a score of >2 were accepted as poor functional outcome. As a result,
within the period of 3 months posttreatment, good functional outcomes were
obtained in 45 (51.1%) patients and poor functional outcomes were obtained in 43
(48.9%) patients. In comparisons, cardioembolic stroke group was statistically
significantly higher in the good functional outcome group (P =
.03). Pretreatment National Institute of Health Stroke Scale (NIHSS) scores
(P < .001), presence of proximal hyperintense middle
cerebral artery sign in noncontrast computed brain tomography
(P = .03), and being aged ≥80 and older (P
= .04) were markedly higher in the group with poor functional outcomes. In
conclusion, our study demonstrated that cardioembolic strokes may have an impact
on good functional outcomes and being aged 80 and older, presence of proximal
HMCAS in computed brain tomography, and pretreatment NIHSS scores may have an
impact on poor functional outcomes.
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Affiliation(s)
- Mustafa Çetiner
- Department of Neurology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Hasan Emre Aydin
- Department of Neurosurgery, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Merve Güler
- Department of Neurology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Sibel Canbaz Kabay
- Department of Neurology, Dumlupınar University Faculty of Medicine, Kütahya, Turkey
| | - Yaşar Zorlu
- Department of Neurology, Ministry of Health Tepecik Teaching and Research Hospital, İzmir, Turkey
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Qin B, Zhao MJ, Chen H, Qin H, Zhao L, Fu L, Qin C, Yang M, Gao W. Real-World Outcomes of Acute Ischemic Stroke Treatment with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:3542-3548. [PMID: 30201455 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/11/2018] [Accepted: 08/08/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Evidence from outside the typical clinical research setting, such as the real-world setting, complements evidence coming from randomized controlled trials. The purpose of this study was to evaluate all available evidence from the real-world observational trials about long-term outcomes of treatment with intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) compared with not treated with IV rt-PA (non-rt-PA) in patients with acute ischemic stroke. METHODS We searched PubMed and Embase until March 1, 2018 for observational studies reporting matched or adjusted results comparing IV rt-PA versus non-rt-PA in patients with acute ischemic stroke. Outcomes assessed included all-cause mortality, hospital readmission rates, and independence rates. Hazard ratios with 95% confidence intervals were used as a measure of comparing between patients treated with IV rt-PA and non-rt-PA. RESULTS Six observational trials with 16,399 participants were identified. The use of IV rt-PA in acute ischemic stroke patients was associated with a lower risk of mortality (hazard ratio .61; 95% confidence interval, .52-.70; P < .00001), and there was no heterogeneity across trials. There was no evidence of an effect on hospital readmission rates and independence rates. CONCLUSIONS IV rt-PA is associated with reduced long-term mortality in acute ischemic stroke patients.
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Affiliation(s)
- Bin Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China
| | - Ming-Jun Zhao
- Department of Pharmacy, The Second Affiliated Hospital of Xinxiang Medical University (Henan Mental Hospital), Xinxiang, China
| | - Hong Chen
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China
| | - Huixun Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China
| | - Libo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Fu
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China
| | - Cheng Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China
| | - Mingxiu Yang
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China
| | - Wen Gao
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou, Guangxi, China.
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