Study Protocol for a Randomized, Double-Blind, Placebo-Controlled, Phase-II Trial: AdrenoMedullin for Ischemic Stroke Study

Clinical Potential of Adrenomedullin Signaling in the Cardiovascular System

Numerous clinical studies have revealed the utility of circulating AM (adrenomedullin) or MR-proAM (mid-regional proAM 45-92) as an effective prognostic and diagnostic biomarker for a variety of cardiovascular-related pathophysiologies. Thus, there is strong supporting evidence encouraging the exploration of the AM-CLR (calcitonin receptor-like receptor) signaling pathway as a therapeutic target. This is further bolstered because several drugs targeting the shared CGRP (calcitonin gene-related peptide)-CLR pathway are already Food and Drug Administration-approved and on the market for the treatment of migraine. In this review, we summarize the AM-CLR signaling pathway and its modulatory mechanisms and provide an overview of the current understanding of the physiological and pathological roles of AM-CLR signaling and the yet untapped potentials of AM as a biomarker or therapeutic target in cardiac and vascular diseases and provide an outlook on the recently emerged strategies that may provide further boost to the possible clinical applications of AM signaling.

Modified Rankin scale assessment by telephone using a simple questionnaire

PURPOSE

The modified Rankin Scale (mRS) is widely used as a measure of post-stroke physical disability in clinical stroke trials; however, it is affected by inter-rater discrepancies. A Japanese version of the simplified mRS questionnaire (J-RASQ) has the potential to overcome the inter-rater discrepancies and might be feasible for clinical surveys. We aimed to determine the reliability of J-RASQ in a telephone survey administered by non-medical staff.

METHODS

We recruited 103 patients (age = 73 ± 11 years; 57% males) with a history of ischemic stroke who visited the outpatient clinic of the department of neurology at our hospital between March and May, 2021. After obtaining informed consent for participation in the study, a stroke neurologist assessed the mRS score during the visit using the Japanese version of mRS. On the same day, a clerk telephoned the patient or his/her family members to administer the J-RASQ. The percentage of agreement between mRS and J-RASQ scores was evaluated using the kappa coefficient and weighted kappa coefficient.

RESULTS

The median time for the telephone survey was 85 s (interquartile range = 70-135 s). The mRS and J-RASQ scores had an agreement of 63.1%, with a kappa statistic of 0.51 (95% confidence interval [CI] = 0.39-0.63). The weighted kappa statistic, which takes into account the extent of disagreement, was 0.81 (95% CI = 0.75-0.88).

CONCLUSION

J-RASQ is easy to administer and reliable for assessment in telephone-based surveys performed by non-medical staff.

Translational studies of adrenomedullin and related peptides regarding cardiovascular diseases

Adrenomedullin (AM) is a vasodilative peptide with various physiological functions, including the maintenance of vascular tone and endothelial barrier function. AM levels are markedly increased during severe inflammation, such as that associated with sepsis; thus, AM is expected to be a useful clinical marker and therapeutic agent for inflammation. However, as the increase in AM levels in cardiovascular diseases (CVDs) is relatively low compared to that in infectious diseases, the value of AM as a marker of CVDs seems to be less important. Limitations pertaining to the administrative route and short half-life of AM in the bloodstream (<30 min) restrict the therapeutic applications of AM for CVDs. In early human studies, various applications of AM for CVDs were attempted, including for heart failure, myocardial infarction, pulmonary hypertension, and peripheral artery disease; however, none achieved success. We have developed AM as a therapeutic agent for inflammatory bowel disease in which the vasodilatory effect of AM is minimized. A clinical trial evaluating this AM formulation for acute cerebral infarction is ongoing. We have also developed AM derivatives that exhibit a longer half-life and less vasodilative activity. These AM derivatives can be administered by subcutaneous injection at long-term intervals. Accordingly, these derivatives will reduce the inconvenience in use compared to that for native AM and expand the possible applications of AM for treating CVDs. In this review, we present the latest translational status of AM and its derivatives.

Diagnostic and prognostic blood biomarkers in vascular dementia: From the viewpoint of ischemic stroke

Reliable quantitative blood biomarkers are important in vascular dementia (VaD) because early diagnosis and therapeutic intervention are effective in preventing progression of dementia. Although many blood biomarkers for acute ischemic stroke (AIS) or VaD have been reported, there are few reliable blood biomarkers. VaD and AIS have similar pathological conditions that are associated with small vessel disease (SVD) such as oxidative stress, inflammation, endothelial dysfunction, and neuronal injury. Therefore, it may be possible to find superior blood biomarkers of VaD among AIS blood biomarkers. Owing to recent developments, noncoding RNAs such as microRNA and long noncoding RNA, which can be analyzed using a single drop of blood, are also particularly reliable VaD markers because they stably reflect brain tissue damage. A multimarker combining several blood biomarkers or artificial intelligence technology may also be beneficial to compensate for insufficiencies of a single blood biomarker. This review describes the blood biomarkers of VaD and how they are related to blood biomarkers of AIS.