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Josić Dominović P, Dobrivojević Radmilović M, Srakočić S, Mišerić I, Škokić S, Gajović S. Validation and application of caged Z-DEVD-aminoluciferin bioluminescence for assessment of apoptosis of wild type and TLR2-deficient mice after ischemic stroke. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2024; 253:112871. [PMID: 38402658 DOI: 10.1016/j.jphotobiol.2024.112871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
Programmed cell death or apoptosis is a critically important mechanism of tissue remodeling and regulates conditions such as cancer, neurodegeneration or stroke. The aim of this research article was to assess the caged Z-DEVD-aminoluciferin substrate for in vivo monitoring of apoptosis after ischemic stroke in TLR2-deficient mice and their TLR2-expressing counterparts. Postischemic inflammation is a significant contributor to ischemic injury development and apoptosis, and it is modified by the TLR2 receptor. Caged Z-DEVD-aminoluciferin is made available for bioluminescence enzymatic reaction by cleavage with activated caspase-3, and therefore it is assumed to be capable of reporting and measuring apoptosis. Apoptosis was investigated for 28 days after stroke in mice which ubiquitously expressed the firefly luciferase transgene. Middle cerebral artery occlusion was performed to achieve ischemic injury, which was followed with magnetic resonance imaging. The scope of apoptosis was determined by bioluminescence with caged Z-DEVD-aminoluciferin, immunofluorescence with activated caspase-3, flow cytometry with annexin-V and TUNEL assay. The linearity of Z-DEVD-aminoluciferin substrate dose effect was shown in the murine brain. Z-DEVD-aminoluciferin was validated as a good tool for monitoring apoptosis following adequate adjustment. By utilizing bioluminescence of Z-DEVD-aminoluciferin after ischemic stroke it was shown that TLR2-deficient mice had lower post-stroke apoptosis than TLR2-expressing wild type mice. In conclusion, Z-DEVD-aminoluciferin could be a valuable tool for apoptosis measurement in living mice.
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Affiliation(s)
- P Josić Dominović
- University of Zagreb School of Medicine, BIMIS - Biomedical Research Center Šalata, and Croatian Institute for Brain Research, Zagreb, Croatia
| | - M Dobrivojević Radmilović
- University of Zagreb School of Medicine, BIMIS - Biomedical Research Center Šalata, and Croatian Institute for Brain Research, Zagreb, Croatia
| | - S Srakočić
- University of Zagreb School of Medicine, BIMIS - Biomedical Research Center Šalata, and Croatian Institute for Brain Research, Zagreb, Croatia
| | - I Mišerić
- University of Zagreb School of Medicine, BIMIS - Biomedical Research Center Šalata, and Croatian Institute for Brain Research, Zagreb, Croatia
| | - S Škokić
- University of Zagreb School of Medicine, BIMIS - Biomedical Research Center Šalata, and Croatian Institute for Brain Research, Zagreb, Croatia
| | - S Gajović
- University of Zagreb School of Medicine, BIMIS - Biomedical Research Center Šalata, and Croatian Institute for Brain Research, Zagreb, Croatia.
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Rajendram P, Ikram A, Fisher M. Combined Therapeutics: Future Opportunities for Co-therapy with Thrombectomy. Neurotherapeutics 2023; 20:693-704. [PMID: 36943636 PMCID: PMC10275848 DOI: 10.1007/s13311-023-01369-1] [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] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Stroke is an urgent public health issue with millions of patients worldwide living with its devastating effects. The advent of thrombolysis and endovascular thrombectomy has transformed the hyperacute care of these patients. However, a significant proportion of patients receiving these therapies still goes on to have unfavorable outcomes and many more remain ineligible for these therapies based on our current guidelines. The future of stroke care will depend on an expansion of the scope of thrombolysis and endovascular thrombectomy to patients outside traditional time windows, more distal occlusions, and large vessel occlusions with mild clinical deficits, for whom clinical trial results have not proven therapeutic efficacy. Novel cytoprotective therapies targeting the ischemic cascade and reperfusion injury therapy, in combination with our existing treatment modalities, should be explored to further improve outcomes for these patients with acute ischemic stroke. In this review, we will review the current status of thrombolysis and thrombectomy, suggest additional data that is needed to enhance these therapies, and discuss how cytoprotection might be combined with thrombectomy.
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Affiliation(s)
- Phavalan Rajendram
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Palmer Building Room 127, 330 Brookline Avenue, Boston, MA, 02215-5400, USA.
| | - Asad Ikram
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Palmer Building Room 127, 330 Brookline Avenue, Boston, MA, 02215-5400, USA
| | - Marc Fisher
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Palmer Building Room 127, 330 Brookline Avenue, Boston, MA, 02215-5400, USA
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Chen C, Li M, Lin L, Chen S, Chen Y, Hong L. Clinical effects and safety of edaravone in treatment of acute ischaemic stroke: A meta-analysis of randomized controlled trials. J Clin Pharm Ther 2021; 46:907-917. [PMID: 33638896 PMCID: PMC8359409 DOI: 10.1111/jcpt.13392] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Edaravone is a new antioxidant and hydroxyl radical scavenger. Although there is evidence that it improves clinical outcomes of patients with acute ischaemic stroke (AIS), it is not yet widely accepted for treatment of AIS in Western countries. We further investigated the efficacy and safety of edaravone through this meta-analysis of randomized controlled clinical trials (RCTs). METHOD Pubmed, Embase, Web of Science and Cochrane Library were screened up to December 2020 for original articles from SCI journals that published in English. RCTs that compared edaravone versus placebo or no intervention in adult patients and reported the efficacy or safety of edaravone were regarded as eligible. Mortality was regarded as the primary outcome and the improvement of neurological impairment was regarded as the secondary outcome. Safety evaluation was conducted according to the incidence of adverse events. Review Manager 5.3 was employed to perform the assessment of the risk of bias and data synthesis. The Cochrane risk of bias tool for randomized controlled trials was employed to assess the risk of bias. RESULTS AND DISCUSSION Seven randomized controlled trials with 2069 patients were included. For the incidence of mortality, the pooled RR for studies that evaluated edaravone after three-month follow-up was 0.55 (95% Cl, 0.43-0.7, I2 = 0, P < 0.01). The pooled RR for improvement of neurological impairment at the three months follow-up was 1.54 (95% CI, 1.27-1.87, I2 = 0, P < 0.01) in four RCTs. On subgroup analysis of studies that were conducted in Asia, the RR was 1.56 (95% CI, 1.27-1.90, I2 = 0%; P < 0.01); the pooled RR for studies that conducted in Europe was 1.32 (95% CI, 0.64-2.72; P = 0.45); the pooled RR for studies that used edaravone for two weeks was 1.42 (95% CI, 1.10 to 1.83, I2 = 0%; P < 0.01); the pooled RR for studies that used edaravone for one week was 1.64 (95% CI, 1.24-2.16, I2 = 0%; P < 0.01); the pooled RR for studies that conducted in patients with mean age equal to or over 60 years was 1.52 (95% CI, 1.24-1.87, I2 = 0%; P < 0.01); and the pooled RR for studies that conducted in patients with mean age less than 60 was 1.80 (95% CI, 1.05-3.08, I2 = 0%; P = 0.03). For the incidence of any treatment-related adverse events, the pooled RR for studies that evaluated edaravone during treatment was 0.83 (95% CI, 0.51-1.34, I2 = 0, P = 0.43). The difference of the incidence of any treatment-related adverse events between two groups was not statistically significant. WHAT IS NEW AND CONCLUSION The limited studies indicate that edaravone can improve neurological impairment with a survival benefit at three-month follow-up, regardless of the mean age and course of treatment. It is worthy of promotion in the clinical treatment of AIS in Asian countries. More well-designed RCTs with larger sample sizes are needed to determine the benefits of edaravone in patients from Western countries.
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Affiliation(s)
- Chongyue Chen
- Department of Emergency Intensive Care UnitThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Mingkai Li
- Zhongshan School of MedicineSun Yat‐Sen UniversityGuangzhouGuangdongChina
| | - Liling Lin
- Department of NeurologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Shuying Chen
- Department of NeurologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Yongru Chen
- Department of Emergency Intensive Care UnitThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Liekai Hong
- Department of CardiovascularThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
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Developing of Focal Ischemia in the Hippocampus or the Amygdala Reveals a Regional Compensation Rule for Fear Memory Acquisition. eNeuro 2021; 8:ENEURO.0398-20.2021. [PMID: 33785521 PMCID: PMC8174052 DOI: 10.1523/eneuro.0398-20.2021] [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: 09/15/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Circuit compensation is often observed in patients with acute ischemic stroke, suggesting the importance of the interaction between brain regions. Also, contextual fear memory is an association between multisensory contexts and fearful stimuli, for which the interaction between the hippocampus and the amygdala is believed to be critical. To understand how focal ischemia in one region could influence the other region, we used a modified photo-thrombosis to induce focal ischemia in the hippocampus or the amygdala or both in freely-moving rats. We found that the learning curve and short-term memory (STM) were not affected in the rats although focal ischemia was induced 5 h before learning in either the hippocampus or the amygdala; these were impaired by the induction of ischemia in both the regions. Furthermore, the learning curve and STM were impaired when ischemia was induced 24 h before learning in either the hippocampus or the amygdala when the synaptic transmission was altered in one region because of ischemia in the other region. These results suggest that the circuit compensation between the hippocampus and the amygdala is critical for fear memory acquisition.
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Rogers JM, Bechara J, Middleton S, Johnstone SJ. Acute EEG Patterns Associated With Transient Ischemic Attack. Clin EEG Neurosci 2019; 50:196-204. [PMID: 30045636 DOI: 10.1177/1550059418790708] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transient ischemic attack (TIA) is characterized by stroke-like neurologic signs and symptoms in the absence of demonstrable structural neuropathology. There is no test for TIA, with classification often reliant on subjective, retrospective report. Functional brain measures such as the electroencephalogram (EEG) may be helpful in objectively detecting and describing the pathophysiology of TIA, but this has not been adequately examined. METHODS EEG was obtained from a single electrode over the left frontal lobe during 3-minute resting-state and auditory oddball conditions administered to consecutive patients within 72 hours of admission to the acute stroke ward of a tertiary hospital. Separately, patients were classified by their treating team as having suffered either an ischemic stroke (n = 10) or a TIA (n = 10). Relative power of delta, theta, alpha, and beta EEG frequency bands were extracted for comparison between the 2 clinical groups and an existing normative sample of 10 healthy, age-, gender-, and education-matched older adults. RESULTS Analysis of variance with post hoc testing identified pronounced delta activity in stroke patients, while alpha and beta power were elevated in TIA patients. Both patient groups exhibited attenuated theta activity compared with healthy controls. Receiver operating characteristic curve analysis identified thresholds for each EEG frequency capable of distinguishing the 3 participant groups. CONCLUSIONS TIA, ischemic stroke, and healthy aging are each associated with distinct electrophysiological profiles. These preliminary findings suggest that acute EEG may be helpful in elucidating the pathophysiology and reversibility of TIA symptoms, and further exploration of the value of this unique functional brain data is encouraged.
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Affiliation(s)
- Jeffrey M Rogers
- 1 Department of Psychology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,2 Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jacob Bechara
- 3 School of Psychology, Australian Catholic University, Sydney, New South Wales, Australia
| | - Sandy Middleton
- 4 Nursing Research Institute, St Vincent's Health Australia and Australian Catholic University, Sydney, New South Wales, Australia
| | - Stuart J Johnstone
- 5 School of Psychology and Brain & Behaviour Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Aminov A, Rogers JM, Johnstone SJ, Middleton S, Wilson PH. Acute single channel EEG predictors of cognitive function after stroke. PLoS One 2017; 12:e0185841. [PMID: 28968458 PMCID: PMC5624638 DOI: 10.1371/journal.pone.0185841] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/20/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early and accurate identification of factors that predict post-stroke cognitive outcome is important to set realistic targets for rehabilitation and to guide patients and their families accordingly. However, behavioral measures of cognition are difficult to obtain in the acute phase of recovery due to clinical factors (e.g. fatigue) and functional barriers (e.g. language deficits). The aim of the current study was to test whether single channel wireless EEG data obtained acutely following stroke could predict longer-term cognitive function. METHODS Resting state Relative Power (RP) of delta, theta, alpha, beta, delta/alpha ratio (DAR), and delta/theta ratio (DTR) were obtained from a single electrode over FP1 in 24 participants within 72 hours of a first-ever stroke. The Montreal Cognitive Assessment (MoCA) was administered at 90-days post-stroke. Correlation and regression analyses were completed to identify relationships between 90-day cognitive function and electrophysiological data, neurological status, and demographic characteristics at admission. RESULTS Four acute qEEG indices demonstrated moderate to high correlations with 90-day MoCA scores: DTR (r = -0.57, p = 0.01), RP theta (r = 0.50, p = 0.01), RP delta (r = -0.47, p = 0.02), and DAR (r = -0.45, p = 0.03). Acute DTR (b = -0.36, p < 0.05) and stroke severity on admission (b = -0.63, p < 0.01) were the best linear combination of predictors of MoCA scores 90-days post-stroke, accounting for 75% of variance. CONCLUSIONS Data generated by a single pre-frontal electrode support the prognostic value of acute DAR, and identify DTR as a potential marker of post-stroke cognitive outcome. Use of single channel recording in an acute clinical setting may provide an efficient and valid predictor of cognitive function after stroke.
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Affiliation(s)
- Anna Aminov
- School of Psychology, Australian Catholic University, Sydney, NSW, Australia
| | | | | | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Australia and Australian Catholic University, Sydney, NSW Australia
| | - Peter H. Wilson
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, VIC, Australia
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7
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Zhu Y, Guo Z, Zhang L, Zhang Y, Chen Y, Nan J, Zhao B, Xiao H, Wang Z, Wang Y. System-wide assembly of pathways and modules hierarchically reveal metabolic mechanism of cerebral ischemia. Sci Rep 2015; 5:17068. [PMID: 26621314 PMCID: PMC4664864 DOI: 10.1038/srep17068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/23/2015] [Indexed: 12/14/2022] Open
Abstract
The relationship between cerebral ischemia and metabolic disorders is poorly understood, which is partly due to the lack of comparative fusing data for larger complete systems and to the complexity of metabolic cascade reactions. Based on the fusing maps of comprehensive serum metabolome, fatty acid and amino acid profiling, we identified 35 potential metabolic biomarkers for ischemic stroke. Our analyses revealed 8 significantly altered pathways by MetPA (Metabolomics Pathway Analysis, impact score >0.10) and 15 significantly rewired modules in a complex ischemic network using the Markov clustering (MCL) method; all of these pathways became more homologous as the number of overlapping nodes was increased. We then detected 24 extensive pathways based on the total modular nodes from the network analysis, 12 of which were new discovery pathways. We provided a new perspective from the viewpoint of abnormal metabolites for the overall study of ischemic stroke as well as a new method to simplify the network analysis by selecting the more closely connected edges and nodes to build a module map of stroke.
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Affiliation(s)
- Yan Zhu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.,Beijing Electric Power Hospital, Capital Medical University, Beijing, 100073, China.,Shanxi Buchang Pharmaceutical Co. Ltd, Xi'an, 712000, China
| | - Zhili Guo
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.,Jiaxing Traditional Chinese Medicine Affiliated Hospital of Zhejiang Chinese Medical University, Jiaxing, 314000, China
| | - Liangxiao Zhang
- Oil Crops Research Institute, Chinese Academy of Agricultural Sciences, Wuhan 430062, China
| | - Yingying Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yinying Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jingyi Nan
- Shanxi Buchang Pharmaceutical Co. Ltd, Xi'an, 712000, China
| | - Buchang Zhao
- Shanxi Buchang Pharmaceutical Co. Ltd, Xi'an, 712000, China
| | - Hongbin Xiao
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zhong Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yongyan Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
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Cao CX, Yang QW, Lv FL, Cui J, Fu HB, Wang JZ. Reduced cerebral ischemia-reperfusion injury in Toll-like receptor 4 deficient mice. Biochem Biophys Res Commun 2006; 353:509-14. [PMID: 17188246 DOI: 10.1016/j.bbrc.2006.12.057] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 12/06/2006] [Indexed: 02/06/2023]
Abstract
Inflammatory reaction plays an important role in cerebral ischemia-reperfusion injury, however, its mechanism is still unclear. Our study aims to explore the function of Toll-like receptor 4 (TLR4) in the process of cerebral ischemia-reperfusion. We made middle cerebral artery ischemia-reperfusion model in mice with line embolism method. Compared with C3H/OuJ mice, scores of cerebral water content, cerebral infarct size and neurologic impairment in C3H/Hej mice were obviously lower after 6 h ischemia and 24 h reperfusion. Light microscopic and electron microscopic results showed that cerebral ischemia-reperfusion injury in C3H/Hej mice was less serious than that in C3H/OuJ mice. TNF-alpha and IL-6 contents in C3H/HeJ mice were obviously lower than that in C3H/OuJ mice with ELISA. The results showed that TLR4 participates in the process of cerebral ischemia-reperfusion injury probably through decrease of inflammatory cytokines. TLR4 may become a new target for prevention of cerebral ischemia-reperfusion injury. Our study suggests that TLR4 is one of the mechanisms of cerebral ischemia-reperfusion injury besides its important role in innate immunity.
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Affiliation(s)
- Can-Xiang Cao
- Department of Neurology, DaPing Hospital, The Third Military Medical University, ChangJiang Branch Road 10, DaPing, YuZhong District, Chongqing 400042, China
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Fatahzadeh M, Glick M. Stroke: epidemiology, classification, risk factors, complications, diagnosis, prevention, and medical and dental management. ACTA ACUST UNITED AC 2006; 102:180-91. [PMID: 16876060 DOI: 10.1016/j.tripleo.2005.07.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Revised: 07/15/2005] [Accepted: 07/29/2005] [Indexed: 10/24/2022]
Abstract
Cerebrovascular accident, or stroke, refers to an acute onset of neurologic deficits lasting more than 24 hours or culminating in death caused by a sudden impairment of cerebral circulation. Stroke is the third leading cause of death and a major cause of long-term disability in the United States. This article provides the dental community with an up-to-date understanding of the epidemiology, classification, risk factors, complications, diagnosis, prevention, and medical and dental management issues pertaining to stroke.
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Affiliation(s)
- Mahnaz Fatahzadeh
- Division of Oral Medicine, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine & Dentistry of New Jersey, Newark, NJ 07103, USA.
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Ovbiagele B, Kidwell CS, Starkman S, Saver JL. Potential role of neuroprotective agents in the treatment of patients with acute ischemic stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2003; 5:441-449. [PMID: 14575621 DOI: 10.1007/s11936-003-0033-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently, intravenous recombinant tissue plasminogen activator is the only US Food and Drug Administration-approved therapy for acute ischemic stroke. Although efficacious, its usefulness is limited, mainly because of the very limited time window for its administration. Neuroprotective treatments are therapies that block the cellular, biochemical, and metabolic elaboration of injury during or after exposure to ischemia, and have a potential role in ameliorating brain injury in patients with acute ischemic stroke. More than 50 neuroprotective agents have reached randomized human clinical trials in focal ischemic stroke, but none have been unequivocally proven efficacious, despite successful preceding animal studies. The failed neuroprotective trials of the past have greatly increased understanding of the fundamental biology of ischemic brain injury and have laid a strong foundation for future advance. Moreover, the recent favorable results of human clinical trials of hypothermia in human cardiac arrest and global brain ischemia have validated the general concept of neuroprotection for ischemic brain injury. Recent innovations in strategies of preclinical drug development and clinical trial design that rectify past defects hold great promise for neuroprotective investigation, including novel approaches to accelerating time to initiation of experimental treatment, use of outcome measures sensitive to treatment effects, and trial testing of combination therapies rather than single agents alone. Although no neuroprotective agent is of proven benefit for focal ischemic stroke, several currently available interventions have shown promising results in preliminary trials and may be considered for cautious, off-label use in acute stroke, including hypothermia, magnesium sulfate, citicoline, albumin, and erythropoietin. Overall, the prospects for safe and effective neuroprotective therapies to improve stroke outcome remain promising.
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Affiliation(s)
- Bruce Ovbiagele
- Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
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11
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Ovbiagele B, Kidwell CS, Starkman S, Saver JL. Potential Role of Neuroprotective Agents in the Treatment of Patients with Acute Ischemic Stroke. Curr Treat Options Neurol 2003; 5:367-375. [PMID: 12895399 DOI: 10.1007/s11940-003-0027-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Currently, intravenous recombinant tissue plasminogen activator is the only US Food and Drug Administration-approved therapy for acute ischemic stroke. Although efficacious, its usefulness is limited, mainly because of the very limited time window for its administration. Neuroprotective treatments are therapies that block the cellular, biochemical, and metabolic elaboration of injury during or after exposure to ischemia, and have a potential role in ameliorating brain injury in patients with acute ischemic stroke. More than 50 neuroprotective agents have reached randomized human clinical trials in focal ischemic stroke, but none has been unequivocally proven efficacious, despite successful preceding animal studies. The failed neuroprotective trials of the past have greatly increased understanding of the fundamental biology of ischemic brain injury and have laid a strong foundation for future advance. Moreover, the recent favorable results of human clinical trials of hypothermia in human cardiac arrest and global brain ischemia have validated the general concept of neuroprotection for ischemic brain injury. Recent innovations in strategies of preclinical drug development and clinical trial design that rectify past defects hold great promise for neuroprotective investigation, including novel approaches to accelerating time to initiation of experimental treatment, use of outcome measures sensitive to treatment effects, and trial testing of combination therapies rather than single agents alone. Although no neuroprotective agent is of proven benefit for focal ischemic stroke, several currently available interventions have shown promising results in preliminary trials and may be considered for cautious, off-label use in acute stroke, including hypothermia, magnesium sulfate, citicoline, albumin, and erythropoietin. Overall, the prospects for safe and effective neuroprotective therapies to improve stroke outcome remain promising.
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Affiliation(s)
- Bruce Ovbiagele
- Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
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12
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Felberg RA, Naidech AM. The 5 Ps of acute ischemic stroke treatment: parenchyma, pipes, perfusion, penumbra, and prevention of complications. South Med J 2003; 96:336-42. [PMID: 12916550 DOI: 10.1097/01.smj.0000063573.56033.a6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is a treatable disease. Despite the therapeutic nihilism of the past, the advent of thrombolysis has changed the way stroke is approached. Acute ischemic stroke is a challenging and heterogeneous disease. Treatment needs to be based on an understanding of the underlying pathophysiology of ischemia. Interventions are designed to improve neuronal salvage and outcome. The underlying tenets of stroke therapy focus on the brain parenchyma, arterial flow (pipes), perfusion, the ischemic milieu or penumbra, and prevention of complications. This article focuses on the practical issues of ischemic stroke care, with a brief review of supporting literature.
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Affiliation(s)
- Robert A Felberg
- Department of Neurology, Ochsner Foundation Clinic and Hospital, New Orleans, LA 70121, USA.
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13
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Ovbiagele B, Kidwell CS, Starkman S, Saver JL. Neuroprotective agents for the treatment of acute ischemic stroke. Curr Neurol Neurosci Rep 2003; 3:9-20. [PMID: 12507405 DOI: 10.1007/s11910-003-0031-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Neuroprotective treatments are therapies designed to interrupt the cellular, biochemical, and metabolic elaboration of injury during or following exposure to ischemia; they encompass a rapidly expanding array of pharmacologic interventions. Various classes of neuroprotective agents have reached phase III efficacy trials in focal ischemic stroke, but none has proven effective, despite successful preceding animal studies. This notwithstanding, recent favorable results of hypothermia in human cardiac arrest trials have validated the general concept of neuroprotection. In addition, the promise of neuroprotective therapy for focal acute ischemic stroke has been renewed by innovations in strategies of preclinical drug development and clinical trial design that rectify past defects, including trial testing of combination therapies rather than single agents and novel approaches to accelerating time to initiation of experimental treatment.
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Affiliation(s)
- Bruce Ovbiagele
- Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
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