1
|
Tian HY, Huang BY, Nie HF, Chen XY, Zhou Y, Yang T, Cheng SW, Mei ZG, Ge JW. The Interplay between Mitochondrial Dysfunction and Ferroptosis during Ischemia-Associated Central Nervous System Diseases. Brain Sci 2023; 13:1367. [PMID: 37891735 PMCID: PMC10605666 DOI: 10.3390/brainsci13101367] [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: 08/01/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Cerebral ischemia, a leading cause of disability and mortality worldwide, triggers a cascade of molecular and cellular pathologies linked to several central nervous system (CNS) disorders. These disorders primarily encompass ischemic stroke, Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy, and other CNS conditions. Despite substantial progress in understanding and treating the underlying pathological processes in various neurological diseases, there is still a notable absence of effective therapeutic approaches aimed specifically at mitigating the damage caused by these illnesses. Remarkably, ischemia causes severe damage to cells in ischemia-associated CNS diseases. Cerebral ischemia initiates oxygen and glucose deprivation, which subsequently promotes mitochondrial dysfunction, including mitochondrial permeability transition pore (MPTP) opening, mitophagy dysfunction, and excessive mitochondrial fission, triggering various forms of cell death such as autophagy, apoptosis, as well as ferroptosis. Ferroptosis, a novel type of regulated cell death (RCD), is characterized by iron-dependent accumulation of lethal reactive oxygen species (ROS) and lipid peroxidation. Mitochondrial dysfunction and ferroptosis both play critical roles in the pathogenic progression of ischemia-associated CNS diseases. In recent years, growing evidence has indicated that mitochondrial dysfunction interplays with ferroptosis to aggravate cerebral ischemia injury. However, the potential connections between mitochondrial dysfunction and ferroptosis in cerebral ischemia have not yet been clarified. Thus, we analyzed the underlying mechanism between mitochondrial dysfunction and ferroptosis in ischemia-associated CNS diseases. We also discovered that GSH depletion and GPX4 inactivation cause lipoxygenase activation and calcium influx following cerebral ischemia injury, resulting in MPTP opening and mitochondrial dysfunction. Additionally, dysfunction in mitochondrial electron transport and an imbalanced fusion-to-fission ratio can lead to the accumulation of ROS and iron overload, which further contribute to the occurrence of ferroptosis. This creates a vicious cycle that continuously worsens cerebral ischemia injury. In this study, our focus is on exploring the interplay between mitochondrial dysfunction and ferroptosis, which may offer new insights into potential therapeutic approaches for the treatment of ischemia-associated CNS diseases.
Collapse
Affiliation(s)
- He-Yan Tian
- School of Medical Technology and Nursing, Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen 518000, China;
| | - Bo-Yang Huang
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Hui-Fang Nie
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Xiang-Yu Chen
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Yue Zhou
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Tong Yang
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Shao-Wu Cheng
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Zhi-Gang Mei
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Jin-Wen Ge
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha 410208, China
- Hunan Academy of Traditional Chinese Medicine, Changsha 410208, China
| |
Collapse
|
2
|
Shan XQ, Luo YY, Chang J, Song JJ, Hao N, Zhao L. Immunomodulation: The next target of mesenchymal stem cell-derived exosomes in the context of ischemic stroke. World J Stem Cells 2023; 15:52-70. [PMID: 37007453 PMCID: PMC10052343 DOI: 10.4252/wjsc.v15.i3.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
Ischemic stroke (IS) is the most prevalent form of brain disease, characterized by high morbidity, disability, and mortality. However, there is still a lack of ideal prevention and treatment measures in clinical practice. Notably, the transplantation therapy of mesenchymal stem cells (MSCs) has been a hot research topic in stroke. Nevertheless, there are risks associated with this cell therapy, including tumor formation, coagulation dysfunction, and vascular occlusion. Also, a growing number of studies suggest that the therapeutic effect after transplantation of MSCs is mainly attributed to MSC-derived exosomes (MSC-Exos). And this cell-free mediated therapy appears to circumvent many risks and difficulties when compared to cell therapy, and it may be the most promising new strategy for treating stroke as stem cell replacement therapy. Studies suggest that suppressing inflammation via modulation of the immune response is an additional treatment option for IS. Intriguingly, MSC-Exos mediates the inflammatory immune response following IS by modulating the central nervous system, the peripheral immune system, and immunomodulatory molecules, thereby promoting neurofunctional recovery after stroke. Thus, this paper reviews the role, potential mechanisms, and therapeutic potential of MSC-Exos in post-IS inflammation in order to identify new research targets.
Collapse
Affiliation(s)
- Xiao-Qian Shan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Yong-Yin Luo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Jun Chang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Jing-Jing Song
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Nan Hao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| | - Lan Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
| |
Collapse
|
3
|
The utility of therapeutic hypothermia on cerebral autoregulation. JOURNAL OF INTENSIVE MEDICINE 2022; 3:27-37. [PMID: 36789361 PMCID: PMC9924009 DOI: 10.1016/j.jointm.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/07/2022]
Abstract
Cerebral autoregulation (CA) dysfunction is a strong predictor of clinical outcome in patients with acute brain injury (ABI). CA dysfunction is a potential pathologic defect that may lead to secondary injury and worse functional outcomes. Early therapeutic hypothermia (TH) in patients with ABI is controversial. Many factors, including patient selection, timing, treatment depth, duration, and rewarming strategy, impact its clinical efficacy. Therefore, optimizing the benefit of TH is an important issue. This paper reviews the state of current research on the impact of TH on CA function, which may provide the basis and direction for CA-oriented target temperature management.
Collapse
|
4
|
The Role of Mitochondrial Dynamin in Stroke. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2504798. [PMID: 35571256 PMCID: PMC9106451 DOI: 10.1155/2022/2504798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/17/2022] [Indexed: 11/25/2022]
Abstract
Stroke is one of the leading causes of death and disability in the world. However, the pathophysiological process of stroke is still not fully clarified. Mitochondria play an important role in promoting nerve survival and are an important drug target for the treatment of stroke. Mitochondrial dysfunction is one of the hallmarks of stroke. Mitochondria are in a state of continuous fission and fusion, which are termed as mitochondrial dynamics. Mitochondrial dynamics are very important for maintaining various functions of mitochondria. In this review, we will introduce the structure and functions of mitochondrial fission and fusion related proteins and discuss their role in the pathophysiologic process of stroke. A better understanding of mitochondrial dynamin in stroke will pave way for the development of new therapeutic options.
Collapse
|
5
|
Cattaneo GF, Herrmann AM, Eiden SA, Wieser M, Kellner E, Doostkam S, Süß P, Kiefer S, Fauth L, Maurer CJ, Wolfertz J, Nitzsche B, Büchert M, Jost T, Ihorst G, Haberstroh J, Mülling C, Strecker C, Niesen WD, Shah MJ, Urbach H, Boltze J, Meckel S. Selective intra-carotid blood cooling in acute ischemic stroke: A safety and feasibility study in an ovine stroke model. J Cereb Blood Flow Metab 2021; 41:3097-3110. [PMID: 34159825 PMCID: PMC8756475 DOI: 10.1177/0271678x211024952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Selective therapeutic hypothermia (TH) showed promising preclinical results as a neuroprotective strategy in acute ischemic stroke. We aimed to assess safety and feasibility of an intracarotid cooling catheter conceived for fast and selective brain cooling during endovascular thrombectomy in an ovine stroke model.Transient middle cerebral artery occlusion (MCAO, 3 h) was performed in 20 sheep. In the hypothermia group (n = 10), selective TH was initiated 20 minutes before recanalization, and was maintained for another 3 h. In the normothermia control group (n = 10), a standard 8 French catheter was used instead. Primary endpoints were intranasal cooling performance (feasibility) plus vessel patency assessed by digital subtraction angiography and carotid artery wall integrity (histopathology, both safety). Secondary endpoints were neurological outcome and infarct volumes.Computed tomography perfusion demonstrated MCA territory hypoperfusion during MCAO in both groups. Intranasal temperature decreased by 1.1 °C/3.1 °C after 10/60 minutes in the TH group and 0.3 °C/0.4 °C in the normothermia group (p < 0.001). Carotid artery and branching vessel patency as well as carotid wall integrity was indifferent between groups. Infarct volumes (p = 0.74) and neurological outcome (p = 0.82) were similar in both groups.Selective TH was feasible and safe. However, a larger number of subjects might be required to demonstrate efficacy.
Collapse
Affiliation(s)
- Giorgio Fm Cattaneo
- Institute for Biomedical Engineering, University of Stuttgart, Stuttgart, Germany
| | - Andrea M Herrmann
- Faculty of Veterinary Medicine, Institute of Veterinary Anatomy, Histology and Embryology, Leipzig University, Leipzig, Germany.,Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian A Eiden
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manuela Wieser
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of MR Physics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Soroush Doostkam
- Department of Neuropathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick Süß
- Department of Neuropathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Selina Kiefer
- Department of Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Fauth
- Department of Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | | | - Björn Nitzsche
- Faculty of Veterinary Medicine, Institute of Veterinary Anatomy, Histology and Embryology, Leipzig University, Leipzig, Germany
| | | | | | - Gabriele Ihorst
- Department of Clinical Trials, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Haberstroh
- Center for Experimental Models and Transgenic Service (CEMT), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Mülling
- Faculty of Veterinary Medicine, Institute of Veterinary Anatomy, Histology and Embryology, Leipzig University, Leipzig, Germany
| | - Christoph Strecker
- Department of Neurology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mukesch J Shah
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Boltze
- School of Live Sciences, University of Warwick, Coventry, UK
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Austria
| |
Collapse
|
6
|
Baker TS, Durbin J, Troiani Z, Ascanio-Cortez L, Baron R, Costa A, Rincon F, Colbourne F, Lyden P, Mayer SA, Kellner CP. Therapeutic hypothermia for intracerebral hemorrhage: Systematic review and meta-analysis of the experimental and clinical literature. Int J Stroke 2021; 17:506-516. [PMID: 34427479 DOI: 10.1177/17474930211044870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracerebral hemorrhage remains the deadliest form of stroke worldwide, inducing neuronal death through a wide variety of pathways. Therapeutic hypothermia is a robust and well-studied neuroprotectant widely used across a variety of specialties. AIMS This review summarizes results from preclinical and clinical studies to highlight the overall effectiveness of therapeutic hypothermia to improve long-term intracerebral hemorrhage outcomes while also elucidating optimal protocol regimens to maximize therapeutic effect. SUMMARY OF REVIEW A systematic review was conducted across three databases to identify trials investigating the use of therapeutic hypothermia to treat intracerebral hemorrhage. A random-effects meta-analysis was conducted on preclinical studies, looking at neurobehavioral outcomes, blood brain barrier breakdown, cerebral edema, hematoma volume, and tissue loss. Several mixed-methods meta-regression models were also performed to adjust for variance and variations in hypothermia induction procedures. Twwenty-one preclinical studies and five human studies were identified. The meta-analysis of preclinical studies demonstrated a significant benefit in behavioral scores (ES = -0.43, p = 0.02), cerebral edema (ES = 1.32, p = 0.0001), and blood brain barrier (ES = 2.73, p ≤ 0.00001). Therapeutic hypothermia was not found to significantly affect hematoma expansion (ES = -0.24, p = 0.12) or tissue loss (ES = 0.06, p = 0.68). Clinical study outcome reporting was heterogeneous; however, there was recurring evidence of therapeutic hypothermia-induced edema reduction. CONCLUSIONS The combined preclinical evidence demonstrates that therapeutic hypothermia reduced multiple cell death mechanisms initiated by intracerebral hemorrhage; yet, there is no definitive evidence in clinical studies. The cooling strategies employed in both preclinical and clinical studies were highly diverse, and focused refinement of cooling protocols should be developed in future preclinical studies. The current data for therapeutic hypothermia in intracerebral hemorrhage remains questionable despite the highly promising indications in preclinical studies. Definitive randomized controlled studies are still required to answer this therapeutic question.
Collapse
Affiliation(s)
- Turner S Baker
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Durbin
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary Troiani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luis Ascanio-Cortez
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebecca Baron
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Costa
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Rincon
- Department of Neurology, Thomas Jefferson University, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Patrick Lyden
- Department of Physiology and Neuroscience, Keck School of Medicine, Zilkha Neurogenetic Institute, University of Southern California, California, USA
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, 8137New York Medical College, Westchester Medical Center Health Network, New York, NY, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
7
|
Klichkhanov NK, Dzhafarova AM. Effect of Mild Hypothermia on the Catalytic Characteristics of Synaptic Acetylcholinesterase during Subtotal Global Cerebral Ischemia in Rats. NEUROCHEM J+ 2021. [DOI: 10.1134/s1819712421030077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Crawford RS, Liu Y, Yuan D, Liu C, Sarkar R, Hu B. Transrectal intracolon cooling prevents paraplegia and mortality in a rat model of aortic occlusion-induced spinal cord ischemia. JVS Vasc Sci 2021; 2:181-193. [PMID: 34761238 PMCID: PMC8567003 DOI: 10.1016/j.jvssci.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Spinal cord ischemia-reperfusion injury (SC-IRI) occurs in many medical conditions such as aneurysm surgical repair but no treatment of SC-IRI is available in clinical practice. The objective of the present study was to develop a novel medical device for the treatment of SC-IRI. METHODS A rat model of SC-IRI was used. A novel transrectal intracolon (TRIC) temperature management device was developed to maintain an intracolon wall temperature at either 37°C (TRIC37°C) or 12°C (TRIC12°C). The upper body temperature was maintained as close as possible to 37°C in both groups. A 2F Fogarty balloon catheter was inserted via the left common carotid artery to block the distal aortic blood flow to the spinal cord. The proximal blood pressure was controlled by the withdrawal and infusion of blood via the jugular vein catheter, such that the distal tail artery blood pressure was maintained at ∼10 mmHg for 13 and 20 minutes, respectively. Next, the balloon was deflated, and TRIC temperature management was continued for an additional 30 minutes to maintain the colon wall temperature at either 37°C or 12°C during the reperfusion period. RESULTS All the rats subjected to 13 minutes of spinal cord ischemia in the TRIC37°C group had developed paraplegia during the postischemic phase. In striking contrast, TRIC at 12°C completely prevented the paraplegia, dramatically improved the arterial blood gas parameters, and avoided the histopathologic injuries to the spinal cord in rats subjected to 13 minutes of spinal cord ischemia. Furthermore, TRIC12°C allowed for the extension of the ischemia duration from 13 minutes to 20 minutes, with significantly reduced functional deficits. CONCLUSIONS Directly cooling the intestine focally with the TRIC device offered an exceptional survival rate and functional improvement after aortic occlusion-induced spinal cord ischemia.
Collapse
Affiliation(s)
- Robert S. Crawford
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Yang Liu
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Dong Yuan
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Chunli Liu
- Veterans Affairs Maryland Health Center System, Baltimore, Md
| | - Rajabrata Sarkar
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Bingren Hu
- Departments of Anesthesiology and Surgery, University of Maryland School of Medicine, Baltimore, Md
- Veterans Affairs Maryland Health Center System, Baltimore, Md
| |
Collapse
|
9
|
Manual Kollareth DJ, Zirpoli H, Ten VS, Deckelbaum RJ. Acute Injection of Omega-3 Triglyceride Emulsion Provides Very Similar Protection as Hypothermia in a Neonatal Mouse Model of Hypoxic-Ischemic Brain Injury. Front Neurol 2021; 11:618419. [PMID: 33519700 PMCID: PMC7843448 DOI: 10.3389/fneur.2020.618419] [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: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Therapeutic hypothermia (HT) is a currently accepted treatment for neonatal asphyxia and is a promising strategy in adult stroke therapy. We previously reported that acute administration of docosahexaenoic acid (DHA) triglyceride emulsion (tri-DHA) protects against hypoxic-ischemic (HI) injury in neonatal mice. We questioned if co-treatment with HT and tri-DHA would achieve synergic effects in protecting the brain from HI injury. Neonatal mice (10-day old) subjected to HI injury were placed in temperature-controlled chambers for 4 h of either HT (rectal temperature 31–32°C) or normothermia (NT, rectal temperature 37°C). Mice were treated with tri-DHA (0.375 g tri-DHA/kg bw, two injections) before and 1 h after initiation of HT. We observed that HT, beginning immediately after HI injury, reduced brain infarct volume similarly to tri-DHA treatment (~50%). Further, HT delayed 2 h post-HI injury provided neuroprotection (% infarct volume: 31.4 ± 4.1 vs. 18.8 ± 4.6 HT), while 4 h delayed HT did not protect against HI insult (% infarct volume: 30.7 ± 5.0 vs. 31.3 ± 5.6 HT). HT plus tri-DHA combination treatment beginning at 0 or 2 h after HI injury did not further reduce infarct volumes compared to HT alone. Our results indicate that HT offers similar degrees of neuroprotection against HI injury compared to tri-DHA treatment. HT can only be provided in tertiary care centers, requires intense monitoring and can have adverse effects. In contrast, tri-DHA treatment may be advantageous in providing a feasible and effective strategy in patients after HI injury.
Collapse
Affiliation(s)
| | - Hylde Zirpoli
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, United States
| | - Vadim S Ten
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Richard J Deckelbaum
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, United States.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| |
Collapse
|
10
|
Therapeutic Hypothermia in Patients with Malignant Ischemic Stroke and Hemicraniectomy—A Systematic Review and Meta-analysis. World Neurosurg 2020; 141:e677-e685. [DOI: 10.1016/j.wneu.2020.05.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
|
11
|
Burkhanova G, Chernova K, Khazipov R, Sheroziya M. Effects of Cortical Cooling on Activity Across Layers of the Rat Barrel Cortex. Front Syst Neurosci 2020; 14:52. [PMID: 32848644 PMCID: PMC7417609 DOI: 10.3389/fnsys.2020.00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022] Open
Abstract
Moderate cortical cooling is known to suppress slow oscillations and to evoke persistent cortical activity. However, the cooling-induced changes in electrical activity across cortical layers remain largely unknown. Here, we performed multi-channel local field potential (LFP) and multi-unit activity (MUA) recordings with linear silicone probes through the layers of single cortical barrel columns in urethane-anesthetized rats under normothermia (38°C) and during local cortical surface cooling (30°C). During cortically generated slow oscillations, moderate cortical cooling decreased delta wave amplitude, delta-wave occurrence, the duration of silent states, and delta wave-locked MUA synchronization. Moderate cortical cooling increased total time spent in the active state and decreased total time spent in the silent state. Cooling-evoked changes in the MUA firing rate in cortical layer 5 (L5) varied from increase to decrease across animals, and the polarity of changes in L5 MUA correlated with changes in total time spent in the active state. The decrease in temperature reduced MUA firing rates in all other cortical layers. Sensory-evoked MUA responses also decreased during cooling through all cortical layers. The cooling-dependent slowdown was detected at the fast time-scale with a decreased frequency of sensory-evoked high-frequency oscillations (HFO). Thus, moderate cortical cooling suppresses slow oscillations and desynchronizes neuronal activity through all cortical layers, and is associated with reduced firing across all cortical layers except L5, where cooling induces variable and non-consistent changes in neuronal firing, which are common features of the transition from slow-wave synchronization to desynchronized activity in the barrel cortex.
Collapse
Affiliation(s)
| | - Kseniya Chernova
- Laboratory of Neurobiology, Kazan Federal University, Kazan, Russia
| | - Roustem Khazipov
- Laboratory of Neurobiology, Kazan Federal University, Kazan, Russia.,Aix Marseille University, INSERM, INMED, Marseille, France
| | - Maxim Sheroziya
- Laboratory of Neurobiology, Kazan Federal University, Kazan, Russia
| |
Collapse
|
12
|
Kuczynski AM, Marzoughi S, Al Sultan AS, Colbourne F, Menon BK, van Es ACGM, Berez AL, Goyal M, Demchuk AM, Almekhlafi MA. Therapeutic Hypothermia in Acute Ischemic Stroke-a Systematic Review and Meta-Analysis. Curr Neurol Neurosci Rep 2020; 20:13. [PMID: 32372297 DOI: 10.1007/s11910-020-01029-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Therapeutic hypothermia (TH) in stroke demonstrates robust neuroprotection in animals but clinical applications remain controversial. We assessed current literature on the efficacy of TH in ischemic stroke. RECENT FINDINGS We conducted a meta-analysis comparing TH versus controls in studies published until June 2019. Controlled studies reporting on ≥ 10 adults with acute ischemic stroke were included. Primary outcome was functional independence (modified Rankin Scale [mRS] ≤ 2). Twelve studies (n = 351 TH, n = 427 controls) were included. Functional independence did not differ between groups (RR 1.17, 95% CI 0.93-1.46, random-effects p = 0.2). Five studies reported individual mRS outcomes and demonstrated a shift toward better outcome with TH (unadjusted cOR 1.57, 95% CI 1.01-2.44, p = 0.05). Overall complications were higher with TH (RR 1.18, 95% CI 1.06-1.32, p < 0.01). We did not observe an overall beneficial effect of TH in this analysis although some studies showed a shift toward better outcome. TH was associated with increased complications.
Collapse
Affiliation(s)
| | - Sina Marzoughi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Bijoy K Menon
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mayank Goyal
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Andrew M Demchuk
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Mohammed A Almekhlafi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada.
| |
Collapse
|
13
|
He Z, Ning N, Zhou Q, Khoshnam SE, Farzaneh M. Mitochondria as a therapeutic target for ischemic stroke. Free Radic Biol Med 2020; 146:45-58. [PMID: 31704373 DOI: 10.1016/j.freeradbiomed.2019.11.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/07/2019] [Accepted: 11/03/2019] [Indexed: 12/24/2022]
Abstract
Stroke is the leading cause of death and physical disability worldwide. Mitochondrial dysfunction has been considered as one of the hallmarks of ischemic stroke and contributes to the pathology of ischemia and reperfusion. Mitochondria is essential in promoting neural survival and neurological improvement following ischemic stroke. Therefore, mitochondria represent an important drug target for stroke treatment. This review discusses the mitochondrial molecular mechanisms underlying cerebral ischemia and involved in reactive oxygen species generation, mitochondrial electron transport dysfunction, mitochondria-mediated regulation of inflammasome activation, mitochondrial dynamics and biogenesis, and apoptotic cell death. We highlight the potential of mitochondrial transfer by stem cells as a therapeutic target for stroke treatment and provide valuable insights for clinical strategies. A better understanding of the roles of mitochondria in ischemia-induced cell death and protection may provide a rationale design of novel therapeutic interventions in the ischemic stroke.
Collapse
Affiliation(s)
- Zhi He
- Department of Pharmacy, Luohe Medical College, Luohe, 462000, China
| | - Niya Ning
- Department of Obstetrics and Gynecology, Shaoling District People's Hospital of Luohe City, Luohe, 462300, China
| | - Qiongxiu Zhou
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, 610052, China.
| | - Seyed Esmaeil Khoshnam
- Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Maryam Farzaneh
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| |
Collapse
|
14
|
Kurisu K, Kim JY, You J, Yenari MA. Therapeutic Hypothermia and Neuroprotection in Acute Neurological Disease. Curr Med Chem 2019; 26:5430-5455. [PMID: 31057103 DOI: 10.2174/0929867326666190506124836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/24/2018] [Accepted: 04/11/2019] [Indexed: 01/07/2023]
Abstract
Therapeutic hypothermia has consistently been shown to be a robust neuroprotectant in many labs studying different models of neurological disease. Although this therapy has shown great promise, there are still challenges at the clinical level that limit the ability to apply this routinely to each pathological condition. In order to overcome issues involved in hypothermia therapy, understanding of this attractive therapy is needed. We review methodological concerns surrounding therapeutic hypothermia, introduce the current status of therapeutic cooling in various acute brain insults, and review the literature surrounding the many underlying molecular mechanisms of hypothermic neuroprotection. Because recent work has shown that body temperature can be safely lowered using pharmacological approaches, this method may be an especially attractive option for many clinical applications. Since hypothermia can affect multiple aspects of brain pathophysiology, therapeutic hypothermia could also be considered a neuroprotection model in basic research, which would be used to identify potential therapeutic targets. We discuss how research in this area carries the potential to improve outcome from various acute neurological disorders.
Collapse
Affiliation(s)
- Kota Kurisu
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, United States
| | - Jong Youl Kim
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, United States.,Departments of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jesung You
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, United States.,Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Midori A Yenari
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, California 94121, United States
| |
Collapse
|
15
|
Lyden P, Anderson A, Rajput P. Therapeutic hypothermia and Type II errors: Do not throw out the baby with the ice water. Brain Circ 2019; 5:203-210. [PMID: 31950096 PMCID: PMC6950510 DOI: 10.4103/bc.bc_53_19] [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: 11/18/2019] [Revised: 11/25/2019] [Accepted: 12/11/2019] [Indexed: 11/04/2022] Open
Abstract
After initial enthusiasm for mild therapeutic hypothermia (TH) treatment after brain injuries, including global cerebral ischemia after cardiac arrest, subsequent trials suggested similar benefit using only targeted temperature management (TTM), with fewer side effects. Globally, effective treatment of brain ischemia with TH has declined. Recent data suggest, however, that TH to 33°C may be superior to TTM. We review the background and rationale underlying TH and TTM. We present previously published data from our own laboratory that confirms TH to 33°C provides superior brain cytoprotection, compared to 35°C or 37°C, over a range of delays to treatment and several durations of TH. We illustrate that the treatment effect size of either or 35 is superior to 37, but the effect size difference between 33 and 35, although significant, is small. We estimate that to demonstrate the superiority of TTM over TH, a clinical trial would need between 3,000 and 9,000 patients depending on the desired treatment effect size. Our review and our own data suggest that TH to 33°C is superior to TTM to 36°C, but an extremely large clinical trial would be needed to demonstrate the difference.
Collapse
Affiliation(s)
- Patrick Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ariana Anderson
- Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA.,Department of Statistics, UCLA, Los Angeles, CA, USA
| | - Padmesh Rajput
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
16
|
Almekhlafi MA, Poli S, Goyal M, Demchuk AM. Therapeutic hypothermia in stroke: Quo Vadis? Brain Circ 2019; 5:157-159. [PMID: 31950090 PMCID: PMC6950514 DOI: 10.4103/bc.bc_62_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mohammed A. Almekhlafi
- Department of Clinical Neurosciences and Radiology, Calgary Stroke Program, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sven Poli
- Department of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Mayank Goyal
- Department of Clinical Neurosciences and Radiology, Calgary Stroke Program, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew M. Demchuk
- Department of Clinical Neurosciences and Radiology, Calgary Stroke Program, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
17
|
Neugebauer H, Schneider H, Kollmar R. Letter by Neugebauer et al. regarding article "Hypothermia after decompressive hemicraniectomy in treatment of malignant middle cerebral artery stroke: comment on the randomized clinical trial". Crit Care 2019; 23:315. [PMID: 31530280 PMCID: PMC6749710 DOI: 10.1186/s13054-019-2600-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hermann Neugebauer
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Augsburg, Germany
| | - Rainer Kollmar
- Department of Neurology and Neurointensive Care, Klinikum Darmstadt, Darmstadt, Germany
| |
Collapse
|
18
|
Lyden PD, Lamb J, Kothari S, Toossi S, Boitano P, Rajput PS. Differential effects of hypothermia on neurovascular unit determine protective or toxic results: Toward optimized therapeutic hypothermia. J Cereb Blood Flow Metab 2019; 39:1693-1709. [PMID: 30461327 PMCID: PMC6727141 DOI: 10.1177/0271678x18814614] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Therapeutic hypothermia (TH) benefits survivors of cardiac arrest and neonatal hypoxic-ischemic injury and may benefit stroke patients. Large TH clinical trials, however, have shown mixed results. Given the substantial pre-clinical literature supporting TH, we explored possible mechanisms for clinical trial variability. Using a standard rodent stroke model (n = 20 per group), we found smaller infarctions after 2 h pre- or post-reperfusion TH compared to 4 h. To explore the mechanism of this discrepancy, we used primary cell cultures of rodent neurons, astrocytes, or endothelial cells subjected to oxygen-glucose deprivation (OGD). Then, cells were randomly assigned to 33℃, 35℃ or 37℃ for varying durations after varying delay times. Both 33 and 35℃ TH effectively preserved all cell types, although 33℃ was superior. Longer cooling durations overcame moderate delays to cooling initiation. In contrast, TH interfered with astrocyte paracrine protection of neurons in a temperature-dependent manner. These findings suggest that longer TH is needed to overcome delays to TH onset, but shorter TH durations may be superior to longer, perhaps due to suppression of astrocytic paracrine support of neurons during injury. We propose a scheme for optimizing TH after cerebral injury to stimulate further studies of cardiac arrest and stroke.
Collapse
Affiliation(s)
- Patrick D Lyden
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jessica Lamb
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shweta Kothari
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shahed Toossi
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Boitano
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Padmesh S Rajput
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
19
|
Baron JC. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat Rev Neurol 2019; 14:325-337. [PMID: 29674752 DOI: 10.1038/s41582-018-0002-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization. Novel therapies aiming to 'freeze' the penumbra - that is, prevent core growth until recanalization is complete - hold potential as adjuncts to mechanical thrombectomy. This Review focuses on nonpharmacological approaches that aim to restore the physiological balance between oxygen delivery to and oxygen demand of the penumbra. Particular emphasis is placed on normobaric oxygen therapy, hypothermia and sensory stimulation. Preclinical evidence and early pilot clinical trials are critically reviewed, and future directions, including clinical translation and trial design issues, are discussed.
Collapse
Affiliation(s)
- Jean-Claude Baron
- Department of Neurology, Hôpital Sainte-Anne, Université Paris 5, INSERM U894, Paris, France.
| |
Collapse
|
20
|
Lutz Y, Loewe A, Meckel S, Dössel O, Cattaneo G. Combined local hypothermia and recanalization therapy for acute ischemic stroke: Estimation of brain and systemic temperature using an energetic numerical model. J Therm Biol 2019; 84:316-322. [PMID: 31466769 DOI: 10.1016/j.jtherbio.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
Local brain hypothermia is an attractive method for providing cerebral neuroprotection for ischemic stroke patients and at the same time reducing systemic side effects of cooling. In acute ischemic stroke patients with large vessel occlusion, combination with endovascular mechanical recanalization treatment could potentially allow for an alleviation of inflammatory and apoptotic pathways in the critical phase of reperfusion. The direct cooling of arterial blood by means of an intra-carotid heat exchange catheter compatible with recanalization systems is a novel promising approach. Focusing on the concept of "cold reperfusion", we developed an energetic model to calculate the rate of temperature decrease during intra-carotid cooling in case of physiological as well as decreased perfusion. Additionally, we discussed and considered the effect and biological significance of temperature decrease on resulting brain perfusion. Our model predicted a 2 °C brain temperature decrease in 8.3, 11.8 and 26.2 min at perfusion rates of 50, 30 and 10ml100g⋅min, respectively. The systemic temperature decrease - caused by the venous blood return to the main circulation - was limited to 0.5 °C in 60 min. Our results underline the potential of catheter-assisted, intracarotid blood cooling to provide a fast and selective brain temperature decrease in the phase of vessel recanalization. This method can potentially allow for a tissue hypothermia during the restoration of the physiological flow and thus a "cold reperfusion" in the setting of mechanical recanalization.
Collapse
Affiliation(s)
- Yannick Lutz
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | | |
Collapse
|
21
|
Kuczynski AM, Demchuk AM, Almekhlafi MA. Therapeutic hypothermia: Applications in adults with acute ischemic stroke. Brain Circ 2019; 5:43-54. [PMID: 31334356 PMCID: PMC6611191 DOI: 10.4103/bc.bc_5_19] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/05/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
The advent of mechanical thrombectomy and increasing alteplase use have transformed the care of patients with acute ischemic stroke. Patients with major arterial occlusions with poor outcomes now have a chance of returning to independent living in more than half of the cases. However, many patients with these severe strokes suffer major disability despite these therapies. The search is ongoing for agents that can be combined with thrombectomy to achieve better recovery through halting infarct growth and mitigating injury after ischemic stroke. Several studies in animals and humans have demonstrated that therapeutic hypothermia (TH) offers potential to interrupt the ischemic cascade, reduce infarct volume, and improve functional independence. We performed a literature search to look up recent advances in the use of TH surrounding the science, efficacy, and feasibility of inducing TH in modern stroke treatments. While protocols remain controversial, there is a real opportunity to combine TH with the existing therapies to improve outcome in adults with acute ischemic stroke.
Collapse
Affiliation(s)
| | - Andrew M Demchuk
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Mohammed A Almekhlafi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada.,O'Brien Institute for Public Health, Calgary, AB, Canada
| |
Collapse
|
22
|
Tejada de Rink MM, Naumann U, Kollmar R, Schwab S, Dietel B, Harada H, Tauchi M. A Single Injection of N-Oleoyldopamine, an Endogenous Agonist for Transient Receptor Potential Vanilloid-1, Induced Brain Hypothermia, but No Neuroprotective Effects in Experimentally Induced Cerebral Ischemia in Rats. Ther Hypothermia Temp Manag 2019; 10:91-101. [PMID: 31084468 DOI: 10.1089/ther.2018.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Targeted temperature management, or therapeutic hypothermia, is a potent neuroprotective approach after ischemic brain injury. Hypothermia should be induced as soon as possible after the onset of acute stroke to assure better outcomes. Accordingly, drugs with a fast-acting hypothermic effect sustainable through the period of emergency transportation to hospital would have clinical advantages. Activation of the transient receptor potential vanilloid-1 (TRPV1) can induce hypothermia. Our immunohistochemical investigations confirmed that TRPV1 was distributed to perivascular and periventricular regions of the rat brain, where TRPV1 can be easily detected by TRPV1 agonists. An endogenous TRPV1 selective agonist, N-oleoyldopamine (OLDA), and a synthetic antagonist, AMG 9810, were injected intraperitoneally into healthy adult male Wister rats, and brain and core temperatures and gross motor activities were monitored. Comparison with baseline temperatures showed that TRPV1 injection immediately induced mild hypothermia (p < 0.05 in brain and p < 0.01 in body), and AMG 9810 induced immediate mild hyperthermia (not significant). However, the OLDA-induced hypothermia did not decrease lesion volume after middle carotid artery occlusion in rats. Relative to vehicle, OLDA yielded poorer outcomes and AMG 9810 yielded better outcomes in neurological scores and lesion size. Our study showed that, as an agonist of TRPV1, OLDA has suitable hypothermia-inducing properties, but did not decrease lesion volume. Therefore, the search for novel TRPV1 agonists and/or antagonists providing hypothermia and neuroprotection should continue. Further investigations should also target OLDA-induced transient hypothermia combined with long-term hypothermia maintenance with surface cooling, which mimics the anticipated clinical use of this class of drug.
Collapse
Affiliation(s)
- Maria Mercedes Tejada de Rink
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ulrike Naumann
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Kollmar
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Barbara Dietel
- Department of Medicine 2-Cardiology and Angiology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Hideki Harada
- Neuroanesthesia Research Laboratory, Cognitive and Molecular Institute of Brain Diseases, Kurume University School of Medicine, Kurume, Japan.,Department of Anesthesiology, Kurume University School of Medicine, Kurume, Japan
| | - Miyuki Tauchi
- Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Medicine 2-Cardiology and Angiology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Molecular Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
23
|
Herrmann AM, Meckel S, Gounis MJ, Kringe L, Motschall E, Mülling C, Boltze J. Large animals in neurointerventional research: A systematic review on models, techniques and their application in endovascular procedures for stroke, aneurysms and vascular malformations. J Cereb Blood Flow Metab 2019; 39:375-394. [PMID: 30732549 PMCID: PMC6421248 DOI: 10.1177/0271678x19827446] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neuroendovascular procedures have led to breakthroughs in the treatment of ischemic stroke, intracranial aneurysms, and intracranial arteriovenous malformations. Due to these substantial successes, there is continuous development of novel and refined therapeutic approaches. Large animal models feature various conceptual advantages in translational research, which makes them appealing for the development of novel endovascular treatments. However, the availability and role of large animal models have not been systematically described so far. Based on comprehensive research in two databases, this systematic review describes current large animal models in neuroendovascular research including their primary use. It may therefore serve as a compact compendium for researchers entering the field or looking for opportunities to refine study concepts. It also describes particular applications for ischemic stroke and aneurysm therapy, as well as for the treatment of arteriovenous malformations. It focuses on most promising study designs and readout parameters, as well as on important pitfalls in endovascular translational research including ways to circumvent them.
Collapse
Affiliation(s)
- Andrea M Herrmann
- 1 Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,2 Faculty of Veterinary Medicine, Institute of Veterinary Anatomy, Histology and Embryology, Leipzig University, Leipzig, Germany
| | - Stephan Meckel
- 1 Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthew J Gounis
- 3 Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leona Kringe
- 1 Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,2 Faculty of Veterinary Medicine, Institute of Veterinary Anatomy, Histology and Embryology, Leipzig University, Leipzig, Germany
| | - Edith Motschall
- 4 Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Mülling
- 2 Faculty of Veterinary Medicine, Institute of Veterinary Anatomy, Histology and Embryology, Leipzig University, Leipzig, Germany
| | - Johannes Boltze
- 5 School of Life Sciences, University of Warwick, UK.,6 Department of Translational Medicine and Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Cell Technology and Institute for Medical and Marine Biotechnology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
24
|
Luo Y, Tang H, Li H, Zhao R, Huang Q, Liu J. Recent advances in the development of neuroprotective agents and therapeutic targets in the treatment of cerebral ischemia. Eur J Med Chem 2019; 162:132-146. [DOI: 10.1016/j.ejmech.2018.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022]
|
25
|
Almekhlafi MA, Colbourne F, Al Sultan AS, Goyal M, Demchuk AM. Selective brain cooling: Let us have a moment of science. J Cereb Blood Flow Metab 2019; 39:182-183. [PMID: 30215541 PMCID: PMC6311662 DOI: 10.1177/0271678x18800274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Selective brain cooling is a promising advent for reducing final infarct volume and improving outcomes in ischemic stroke victims. Despite the robust body of evidence from animal studies, evidence supporting the use of selective hypothermia in stroke patients is lacking. A recent study provided promising results on the safety and possible efficacy of selective brain hypothermia via intraarterial infusion of cooled saline. Better understanding of the patients' population that may attain benefit from this approach will be informative. Details of infarct progression using perfusion imaging will also help understand the mechanism of effect of selective hypothermia to inform future trials.
Collapse
Affiliation(s)
- Mohammed A Almekhlafi
- 1 Department of Clinical Neurosciences, at Cumming school of Medicine, University of Calgary, Alberta, Canada.,2 Department of Radiology at Cumming school of Medicine, University of Calgary, Alberta, Canada.,3 Hotchkiss Brain Institute at Cumming school of Medicine, University of Calgary, Alberta, Canada
| | - Fred Colbourne
- 4 Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.,5 Department of Psychology, University of Alberta, Edmonton, Canada
| | - Abdulaziz S Al Sultan
- 1 Department of Clinical Neurosciences, at Cumming school of Medicine, University of Calgary, Alberta, Canada.,3 Hotchkiss Brain Institute at Cumming school of Medicine, University of Calgary, Alberta, Canada
| | - Mayank Goyal
- 2 Department of Radiology at Cumming school of Medicine, University of Calgary, Alberta, Canada.,3 Hotchkiss Brain Institute at Cumming school of Medicine, University of Calgary, Alberta, Canada
| | - Andrew M Demchuk
- 1 Department of Clinical Neurosciences, at Cumming school of Medicine, University of Calgary, Alberta, Canada.,3 Hotchkiss Brain Institute at Cumming school of Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
26
|
Kaffman A, White JD, Wei L, Johnson FK, Krystal JH. Enhancing the Utility of Preclinical Research in Neuropsychiatry Drug Development. Methods Mol Biol 2019; 2011:3-22. [PMID: 31273690 DOI: 10.1007/978-1-4939-9554-7_1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Most large pharmaceutical companies have downscaled or closed their clinical neuroscience research programs in response to the low clinical success rate for drugs that showed tremendous promise in animal experiments intended to model psychiatric pathophysiology. These failures have raised serious concerns about the role of preclinical research in the identification and evaluation of new pharmacotherapies for psychiatry. In the absence of a comprehensive understanding of the neurobiology of psychiatric disorders, the task of developing "animal models" seems elusive. The purpose of this review is to highlight emerging strategies to enhance the utility of preclinical research in the drug development process. We address this issue by reviewing how advances in neuroscience, coupled with new conceptual approaches, have recently revolutionized the way we can diagnose and treat common psychiatric conditions. We discuss the implications of these new tools for modeling psychiatric conditions in animals and advocate for the use of systematic reviews of preclinical work as a prerequisite for conducting psychiatric clinical trials. We believe that work in animals is essential for elucidating human psychopathology and that improving the predictive validity of animal models is necessary for developing more effective interventions for mental illness.
Collapse
Affiliation(s)
- Arie Kaffman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Jordon D White
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lan Wei
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Frances K Johnson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
27
|
Meadows KL. Experimental models of focal and multifocal cerebral ischemia: a review. Rev Neurosci 2018; 29:661-674. [PMID: 29397392 DOI: 10.1515/revneuro-2017-0076] [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: 08/30/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023]
Abstract
Rodent and rabbit stroke models have been instrumental in our current understanding of stroke pathophysiology; however, translational failure is a significant problem in preclinical ischemic stroke research today. There are a number of different focal cerebral ischemia models that vary in their utility, pathophysiology of causing disease, and their response to treatments. Unfortunately, despite active preclinical research using these models, treatment options for ischemic stroke have not significantly advanced since the food and drug administration approval of tissue plasminogen activator in 1996. This review aims to summarize current stroke therapies, the preclinical experimental models used to help develop stroke therapies, as well as their advantages and limitations. In addition, this review discusses the potential for naturally occurring canine ischemic stroke models to compliment current preclinical models and to help bridge the translational gap between small mammal models and human clinical trials.
Collapse
Affiliation(s)
- Kristy L Meadows
- Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, Grafton, MA 01536, USA
| |
Collapse
|
28
|
Liu F, Lu J, Manaenko A, Tang J, Hu Q. Mitochondria in Ischemic Stroke: New Insight and Implications. Aging Dis 2018; 9:924-937. [PMID: 30271667 PMCID: PMC6147588 DOI: 10.14336/ad.2017.1126] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/26/2017] [Indexed: 12/21/2022] Open
Abstract
Stroke is the leading cause of death and adult disability worldwide. Mitochondrial dysfunction has been regarded as one of the hallmarks of ischemia/reperfusion (I/R) induced neuronal death. Maintaining the function of mitochondria is crucial in promoting neuron survival and neurological improvement. In this article, we review current progress regarding the roles of mitochondria in the pathological process of cerebral I/R injury. In particular, we emphasize on the most critical mechanisms responsible for mitochondrial quality control, as well as the recent findings on mitochondrial transfer in acute stroke. We highlight the potential of mitochondria as therapeutic targets for stroke treatment and provide valuable insights for clinical strategies.
Collapse
Affiliation(s)
- Fan Liu
- 1Discipline of Neuroscience, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianfei Lu
- 1Discipline of Neuroscience, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anatol Manaenko
- 2Departments of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Junjia Tang
- 3Department of neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qin Hu
- 1Discipline of Neuroscience, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
29
|
Neuroprotective Effects of Nasopharyngeal Perfluorochemical Cooling in a Rat Model of Subarachnoid Hemorrhage. World Neurosurg 2018; 121:e481-e492. [PMID: 30267945 DOI: 10.1016/j.wneu.2018.09.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) frequently results in severe morbidity, even mortality. Hypothermia is known to have a neuroprotective effect in ischemic injuries. The aim of this study was to determine whether nasopharyngeal (NP) perfluorochemical (PFC) cooling could be used in a rat model of SAH model for neuroprotection. METHODS SAH was induced in 16 male Sprague-Dawley rats by cisterna magna injection of 0.3 mL autologous blood. Vital signs, temperatures, cerebral blood flow (CBF), and brain histology were assessed. Brain cooling was performed on the treatment group using the NP-PFC method starting from 20 minutes after SAH. RESULTS No SAH-related deaths were observed in either group. SAH caused an immediate decrease in mean arterial pressure (17.0% ± 4.90% below baseline values). SAH induction caused a significant and rapid decrease in CBF from baseline (approximately -65%, ranging from -32% to -85%) in both hemispheres. In the left hemisphere, cooling facilitated the return of CBF to baseline values within 20 minutes of treatment with further increase in CBF that stabilized by the 2 hours after injury time point. Quantitative immunohistochemistry showed that there were significantly more NeuN-positive cells in the cortex and significantly fewer IBA-1-positive microglia and glial fibrillary acidic protein-positive astrocytes cells in both cortex and hippocampus in the animals that received NP-PFC cooling compared with no treatment, reflecting preserved neuronal integrity and reduced inflammation. CONCLUSIONS The data from this study indicate that local hypothermia by NP-PFC cooling supports return of CBF and neuronal integrity and suppresses the inflammatory response in SAH, suggestive of a promising neuroprotective approach in management of SAH.
Collapse
|
30
|
Abstract
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management.
Collapse
|
31
|
Abstract
Evidence from animal models indicates that lowering temperature by a few degrees can produce substantial neuroprotection. In humans, hypothermia has been found to be neuroprotective with a significant impact on mortality and long-term functional outcome only in cardiac arrest and neonatal hypoxic-ischemic encephalopathy. Clinical trials have explored the potential role of maintaining normothermia and treating fever in critically ill brain injured patients. This review concentrates on basic concepts to understand the physiologic interactions of thermoregulation, effects of thermal modulation in critically ill patients, proposed mechanisms of action of temperature modulation, and practical aspects of targeted temperature management.
Collapse
Affiliation(s)
- Fred Rincon
- Division of Critical Care and Neurotrauma, Department of Neurology, Sidney-Kimmel College of Medicine, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA; Division of Critical Care and Neurotrauma, Department of Neurological Surgery, Sidney-Kimmel College of Medicine, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
| |
Collapse
|
32
|
Park HS, Choi JH. Safety and Efficacy of Hypothermia (34°C) after Hemicraniectomy for Malignant MCA Infarction. J Korean Neurosurg Soc 2018. [PMID: 29526071 PMCID: PMC5853190 DOI: 10.3340/jkns.2016.1111.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The beneficial effect of hypothermia after hemicraniectomy in malignant middle cerebral artery (MCA) infarction has been controversial. We aim to investigate the safety and clinical efficacy of hypothermia after hemicraniectomy in malignant MCA infarction. METHODS From October 2012 to February 2016, 20 patients underwent hypothermia (Blanketrol III, Cincinnati Sub-Zero, Cincinnati, OH, USA) at 34°C after hemicraniectomy in malignant MCA infarction (hypothermia group). The indication of hypothermia included acute cerebral infarction >2/3 of MCA territory and a Glasgow coma scale (GCS) score <11 with a midline shift >10 mm or transtentorial herniation sign (a fixed and dilated pupil). We retrospectively collected 27 patients, as the control group, who had undergone hemicraniectomy alone and simultaneously met the inclusion criteria of hypothermia between January 2010 and September 2012, before hypothermia was implemented as a treatment strategy in Dong-A University Hospital. We compared the mortality rate between the two groups and investigated hypothermia-related complications, such as postoperative bleeding, pneumonia, sepsis and arrhythmia. RESULTS The age, preoperative infarct volume, GCS score, National institutes of Health Stroke Scale score, and degree of midline shift were not significantly different between the two groups. Of the 20 patients in the hypothermia group, 11 patients were induced with hypothermia immediately after hemicraniectomy and hypothermia was initiated in 9 patients after the decision of hypothermia during postoperative care. The duration of hypothermia was 4±2 days (range, 1 to 7 days). The side effects of hypothermia included two patients with arrhythmia, one with sepsis, one with pneumonia, and one with hypotension. Three cases of hypothermia were discontinued due to these side effects (one sepsis, one hypotension, and one bradycardia). The mortality rate of the hypothermia group was 15.0% and that of the control group was 40.7% (p=0.056). On the basis of the logistic regression analysis, hypothermia was considered to contribute to the decrease in mortality rate (odds ratio, 6.21; 95% confidence interval, 1.04 to 37.05; p=0.045). CONCLUSION This study suggests that hypothermia after hemicraniectomy is a viable option when the progression of patients with malignant MCA infarction indicate poor prognosis.
Collapse
Affiliation(s)
- Hyun-Seok Park
- Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, Dong-A University College of Medicine, Busan, Korea
| | - Jae-Hyung Choi
- Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
33
|
Kurisu K, Yenari MA. Therapeutic hypothermia for ischemic stroke; pathophysiology and future promise. Neuropharmacology 2017; 134:302-309. [PMID: 28830757 DOI: 10.1016/j.neuropharm.2017.08.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 01/08/2023]
Abstract
Therapeutic hypothermia, or cooling of the body or brain for the purposes of preserving organ viability, is one of the most robust neuroprotectants at both the preclinical and clinical levels. Although therapeutic hypothermia has been shown to improve outcome from related clinical conditions, the significance in ischemic stroke is still under investigation. Numerous pre-clinical studies of therapeutic hypothermia has suggested optimal cooling conditions, such as depth, duration, and temporal therapeutic window for effective neuroprotection. Several studies have also explored mechanisms underlying the mechanisms of neuroprotection by therapeutic hypothermia. As such, it appears that cooling affects multiple aspects of brain pathophysiology, and regulates almost every pathway involved in the evolution of ischemic stroke. This multifaceted mechanism is thought to contribute to its strong neuroprotective effect. In order to carry out this therapy in optimal clinical settings, methodological and pathophysiological understanding is crucial. However, more investigation is still needed to better understand the underlying mechanisms of this intervention, and to overcome clinical barriers which seem to preclude the routine use therapeutic hypothermia in stroke. This article is part of the Special Issue entitled 'Cerebral Ischemia'.
Collapse
Affiliation(s)
- Kota Kurisu
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Midori A Yenari
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
| |
Collapse
|
34
|
Reprint of: Hydrogen sulfide in stroke: Protective or deleterious? Neurochem Int 2017; 107:78-87. [DOI: 10.1016/j.neuint.2016.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022]
|
35
|
de Ridder IR, Dippel DW, van der Worp HB. Response by de Ridder et al to Letter Regarding Article, “PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2) Results of a Randomized, Double-Blind Placebo-Controlled Clinical Trial”. Stroke 2017; 48:e177. [DOI: 10.1161/strokeaha.117.017612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Inger R. de Ridder
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Diederik W.J. Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - H. Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
36
|
Muengtaweepongsa S, Srivilaithon W. Targeted temperature management in neurological intensive care unit. World J Methodol 2017; 7:55-67. [PMID: 28706860 PMCID: PMC5489424 DOI: 10.5662/wjm.v7.i2.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/12/2017] [Accepted: 05/18/2017] [Indexed: 02/06/2023] Open
Abstract
Targeted temperature management (TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy (HIE). In addition, TTM is also useful for treatment of elevated intracranial pressure (ICP). HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit (ICU). The most common cause of HIE is cardiac arrest. Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest. Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies. Several methods of TTM have been reported in the literature. TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.
Collapse
|
37
|
Chan SJ, Wong PTH. Hydrogen sulfide in stroke: Protective or deleterious? Neurochem Int 2017; 105:1-10. [DOI: 10.1016/j.neuint.2016.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023]
|
38
|
Wang S, Gu X, Paudyal R, Wei L, Dix TA, Yu SP, Zhang X. Longitudinal MRI evaluation of neuroprotective effects of pharmacologically induced hypothermia in experimental ischemic stroke. Magn Reson Imaging 2017; 40:24-30. [PMID: 28377304 DOI: 10.1016/j.mri.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/07/2017] [Accepted: 03/30/2017] [Indexed: 01/21/2023]
Abstract
Pharmacologically induced hypothermia (PIH) shows promising neuroprotective effects after stroke insult. However, the dynamic evolution of stroke infarct during the hypothermic therapy has not been understood very well. In the present study, MRI was utilized to longitudinally characterize the infarct evolution in a mouse model of ischemic stroke treated by PIH using the neurotensin agonist HPI201. Adult male C57BL/6 mice underwent permanent occlusion of the right middle cerebra artery (MCA). Each animal received a vehicle or HPI201 intraperitoneal injection. The temporal changes of stroke lesion were examined using T2-weighted imaging and diffusion-weighted imaging (DWI) in the acute phase (1-3h) and 24h post stroke. Significantly reduced infarct and edema volumes were observed in PIH treated stroke mice, in agreement with TTC staining findings. Also, the TUNEL staining results indicated apoptotic cells were widely distributed among the ischemic cortex in control group but limited in PIH treated mice. Dramatically reduced growth rate of infarction was seen in PIH treated stroke mice. These results demonstrate HPI201 has strong neuroprotection effects during acute stroke. In particular, MRI with the numerical modelling of temporal infarct evolution could provide a unique means to examine and predict the dynamic response of the PIH treatment on infarct evolution.
Collapse
Affiliation(s)
- Silun Wang
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States
| | - Xiaohuan Gu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Ramesh Paudyal
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Ling Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Thomas A Dix
- Department of Drug Discovery Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; JT Pharmaceuticals Inc., Mt. Pleasant, SC 29464, United States
| | - Shan P Yu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA 30033, United States.
| | - Xiaodong Zhang
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States; Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States.
| |
Collapse
|
39
|
de Ridder IR, den Hertog HM, van Gemert HMA, Schreuder AHCMLT, Ruitenberg A, Maasland EL, Saxena R, van Tuijl JH, Jansen BPW, Van den Berg-Vos RM, Vermeij F, Koudstaal PJ, Kappelle LJ, Algra A, van der Worp HB, Dippel DWJ. PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2): Results of a Randomized, Double-Blind Placebo-Controlled Clinical Trial. Stroke 2017; 48:977-982. [PMID: 28289240 DOI: 10.1161/strokeaha.116.015957] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/04/2017] [Accepted: 01/23/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Subfebrile body temperature and fever in the first days after stroke are strongly associated with unfavorable outcome. A subgroup analysis of a previous trial suggested that early treatment with paracetamol may improve functional outcome in patients with acute stroke and a body temperature of ≥36.5°C. In the present trial, we aimed to confirm this finding. METHODS PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2) was a multicenter, randomized, double-blind, placebo-controlled clinical trial. We aimed to include 1500 patients with acute ischemic stroke or intracerebral hemorrhage within 12 hours of symptom onset. Patients were treated with paracetamol in a daily dose of 6 g or matching placebo for 3 consecutive days. The primary outcome was functional outcome at 3 months, assessed with the modified Rankin Scale and analyzed with multivariable ordinal logistic regression. Because of slow recruitment and lack of funding, the study was stopped prematurely. RESULTS Between December 2011 and October 2015, we included 256 patients, of whom 136 (53%) were allocated to paracetamol. In this small sample, paracetamol had no effect on functional outcome (adjusted common odds ratio, 1.15; 95% confidence interval, 0.74-1.79). There was no difference in the number of serious adverse events (paracetamol n=35 [26%] versus placebo n=28 [24%]). CONCLUSIONS Treatment with high-dose paracetamol seemed to be safe. The effect of high-dose paracetamol on functional outcome remains uncertain. Therefore, a large trial of early treatment with high-dose paracetamol is still needed. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR2365.
Collapse
Affiliation(s)
- Inger R de Ridder
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.).
| | - Heleen M den Hertog
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - H Maarten A van Gemert
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - A H C M L Tobien Schreuder
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Annemieke Ruitenberg
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - E Lisette Maasland
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Ritu Saxena
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Jordie H van Tuijl
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Ben P W Jansen
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Renske M Van den Berg-Vos
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Frederique Vermeij
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Peter J Koudstaal
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - L Jaap Kappelle
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Ale Algra
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - H Bart van der Worp
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | - Diederik W J Dippel
- From the Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands (I.R.d.R., P.J.K., D.W.J.D.); Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands (H.M.d.H.); Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands (H.M.A.v.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands (A.H.C.M.L.T.S.); Department of Neurology, Admiraal de Ruyter Hospital, Goes, The Netherlands (A.R.); Department of Neurology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands (E.L.M.); Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands (R.S.); Department of Neurology, Elisabeth Twee Steden Hospital, Tilburg, The Netherlands (J.H.v.T., B.P.W.J.); Department of Neurology, OLVG location West, Amsterdam, The Netherlands (R.M.V.d.B.-V.); Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands (F.V.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands (L.J.K., A.A., H.B.v.d.W.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (A.A.)
| | | |
Collapse
|
40
|
Geurts M, Petersson J, Brizzi M, Olsson-Hau S, Luijckx GJ, Algra A, Dippel DW, Kappelle LJ, van der Worp HB. COOLIST (Cooling for Ischemic Stroke Trial). Stroke 2017; 48:219-221. [DOI: 10.1161/strokeaha.116.014757] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/01/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Animal studies suggest that cooling improves outcome after ischemic stroke. We assessed the feasibility and safety of surface cooling to different target temperatures in awake patients with acute ischemic stroke.
Methods—
A multicenter, randomized, open, phase II, clinical trial, comparing standard treatment with surface cooling to 34.0°C, 34.5°C, or 35.0°C in awake patients with acute ischemic stroke and an National Institutes of Health Stroke Scale score of ≥6, initiated within 4.5 hours after symptom onset and maintained for 24 hours. The primary outcome was feasibility, defined as the proportion of patients who had successfully completed the assigned treatment. Safety was a secondary outcome.
Results—
Inclusion was terminated after 22 patients because of slow recruitment. Five patients were randomized to 34.0°C, 6 to 34.5°C, 5 to 35.0°C (cooling was initiated in 4), and 6 to standard care. No (0%), 1 (17%), and 3 (75%) patients, respectively, completed the assigned treatment (
P
=0.03). No (0%), 2 (33%), and 4 (100%) patients reached the target temperature (
P
=0.01). Pneumonia occurred in 8 cooled patients but not in controls (absolute risk increase, 53%; 95% confidence interval, 28–79%;
P
=0.002).
Conclusions—
In awake patients with acute ischemic stroke, surface cooling is feasible to 35.0°C, but not to 34.5°C and 34.0°C. Cooling is associated with an increased risk of pneumonia.
Clinical Trial Registration—
URL:
http://www.trialregister.nl
. Unique identifier: NTR2616.
Collapse
Affiliation(s)
- Marjolein Geurts
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - Jesper Petersson
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - Marco Brizzi
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - Stefan Olsson-Hau
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - Gert-Jan Luijckx
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - Ale Algra
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - Diederik W.J. Dippel
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - L. Jaap Kappelle
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| | - H. Bart van der Worp
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.G., L.J.K., H.B.v.d.W.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; Department of Neurology, Skåne University Hospital, Malmö, Sweden (J.P., M.B., S.O.-H.); Department of Neurology, University Medical Center Groningen, The Netherlands (G.-J.L.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.)
| |
Collapse
|
41
|
Brown DA, Wijdicks EFM. Decompressive craniectomy in acute brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:299-318. [PMID: 28187804 DOI: 10.1016/b978-0-444-63600-3.00016-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Decompressive surgery to reduce pressure under the skull varies from a burrhole, bone flap to removal of a large skull segment. Decompressive craniectomy is the removal of a large enough segment of skull to reduce refractory intracranial pressure and to maintain cerebral compliance for the purpose of preventing neurologic deterioration. Decompressive hemicraniectomy and bifrontal craniectomy are the most commonly performed procedures. Bifrontal craniectomy is most often utilized with generalized cerebral edema in the absence of a focal mass lesion and when there are bilateral frontal contusions. Decompressive hemicraniectomy is most commonly considered for malignant middle cerebral artery infarcts. The ethical predicament of deciding to go ahead with a major neurosurgical procedure with the purpose of avoiding brain death from displacement, but resulting in prolonged severe disability in many, are addressed. This chapter describes indications, surgical techniques, and complications. It reviews results of recent clinical trials and provides a reasonable assessment for practice.
Collapse
Affiliation(s)
- D A Brown
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - E F M Wijdicks
- Division of Critical Care Neurology, Mayo Clinic and Neurosciences Intensive Care Unit, Mayo Clinic Campus, Saint Marys Hospital, Rochester, MN, USA.
| |
Collapse
|
42
|
Iglesias-Rey R, Vieites-Prado A, Argibay B, Campos F, Bañobre-López M, Sobrino T, Rivas J, Castillo J. Magnetocaloric effect for inducing hypothermia as new therapeutic strategy for stroke: A physical approach. J Appl Biomed 2017. [DOI: 10.1016/j.jab.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
43
|
Melmed KR, Lyden PD. Meta-Analysis of Pre-Clinical Trials of Therapeutic Hypothermia for Intracerebral Hemorrhage. Ther Hypothermia Temp Manag 2016; 7:141-146. [PMID: 27906602 DOI: 10.1089/ther.2016.0033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Therapeutic hypothermia (TH) is a potent neuroprotectant for experimental ischemic stroke, but studies of TH for intracerebral hemorrhage (ICH) are emerging. We systematically reviewed the experimental literature to assess TH efficacy for ICH. We found 18 suitable papers; quality scores were moderately good. Compared with normothermia, TH reduced measures of edema (mean effect size (95% CI) -1.6873 (-2.3640, -1.0106), p < 0.0001) or blood-brain barrier leakage (p < 0.0001) and improved behavioral outcomes (p < 0.0001). There was no evidence of publication bias. In this meta-analysis of available preclinical studies of ICH, TH is potently effective for reducing perihematomal edema and for improving behavioral outcomes.
Collapse
Affiliation(s)
- Kara R Melmed
- Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California
| | - Patrick D Lyden
- Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California
| |
Collapse
|
44
|
Lee JH, Wei ZZ, Cao W, Won S, Gu X, Winter M, Dix TA, Wei L, Yu SP. Regulation of therapeutic hypothermia on inflammatory cytokines, microglia polarization, migration and functional recovery after ischemic stroke in mice. Neurobiol Dis 2016; 96:248-260. [PMID: 27659107 PMCID: PMC5161414 DOI: 10.1016/j.nbd.2016.09.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/30/2016] [Accepted: 09/17/2016] [Indexed: 01/08/2023] Open
Abstract
Stroke is a leading threat to human life and health in the US and around the globe, while very few effective treatments are available for stroke patients. Preclinical and clinical studies have shown that therapeutic hypothermia (TH) is a potential treatment for stroke. Using novel neurotensin receptor 1 (NTR1) agonists, we have demonstrated pharmacologically induced hypothermia and protective effects against brain damages after ischemic stroke, hemorrhage stroke, and traumatic brain injury (TBI) in rodent models. To further characterize the mechanism of TH-induced brain protection, we examined the effect of TH (at ±33°C for 6h) induced by the NTR1 agonist HPI-201 or physical (ice/cold air) cooling on inflammatory responses after ischemic stroke in mice and oxygen glucose deprivation (OGD) in cortical neuronal cultures. Seven days after focal cortical ischemia, microglia activation in the penumbra reached a peak level, which was significantly attenuated by TH treatments commenced 30min after stroke. The TH treatment decreased the expression of M1 type reactive factors including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-12, IL-23, and inducible nitric oxide synthase (iNOS) measured by RT-PCR and Western blot analyses. Meanwhile, TH treatments increased the expression of M2 type reactive factors including IL-10, Fizz1, Ym1, and arginase-1. In the ischemic brain and in cortical neuronal/BV2 microglia cultures subjected to OGD, TH attenuated the expression of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α), two key chemokines in the regulation of microglia activation and infiltration. Consistently, physical cooling during OGD significantly decreased microglia migration 16h after OGD. Finally, TH improved functional recovery at 1, 3, and 7days after stroke. This study reveals the first evidence for hypothermia mediated regulation on inflammatory factor expression, microglia polarization, migration and indicates that the anti-inflammatory effect is an important mechanism underlying the brain protective effects of a TH therapy.
Collapse
Affiliation(s)
- Jin Hwan Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States
| | - Zheng Z Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States
| | - Wenyuan Cao
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Soonmi Won
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Xiaohuan Gu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States
| | - Megan Winter
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Thomas A Dix
- JT Pharmaceuticals, Mt. Pleasant, SC 29464, United States; Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29401, United States
| | - Ling Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Shan Ping Yu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322, United States; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, United States.
| |
Collapse
|
45
|
The Enhancing Effect of Focused Ultrasound on TNK-Tissue Plasminogen Activator-Induced Thrombolysis Using an In Vitro Circulating Flow Model. J Stroke Cerebrovasc Dis 2016; 25:2891-2899. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/30/2016] [Indexed: 01/03/2023] Open
|
46
|
Guerram M, Zhang LY, Jiang ZZ. G-protein coupled receptors as therapeutic targets for neurodegenerative and cerebrovascular diseases. Neurochem Int 2016; 101:1-14. [PMID: 27620813 DOI: 10.1016/j.neuint.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 12/24/2022]
Abstract
Neurodegenerative and cerebrovascular diseases are frequent in elderly populations and comprise primarily of dementia (mainly Alzheimer's disease) Parkinson's disease and stroke. These neurological disorders (NDs) occur as a result of neurodegenerative processes and represent one of the most frequent causes of death and disability worldwide with a significant clinical and socio-economic impact. Although NDs have been characterized for many years, the exact molecular mechanisms that govern these pathologies or why they target specific individuals and specific neuronal populations remain unclear. As research progresses, many similarities appear which relate these diseases to one another on a subcellular level. Discovering these similarities offers hope for therapeutic advances that could ameliorate the conditions of many diseases simultaneously. G-protein coupled receptors (GPCRs) are the most abundant receptor type in the central nervous system and are linked to complex downstream pathways, manipulation of which may have therapeutic application in many NDs. This review will highlight the potential use of neurotransmitter GPCRs as emerging therapeutic targets for neurodegenerative and cerebrovascular diseases.
Collapse
Affiliation(s)
- Mounia Guerram
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; Faculty of Exact Sciences and Nature and Life Sciences, Department of Biology, Larbi Ben M'hidi University, Oum El Bouaghi 04000, Algeria
| | - Lu-Yong Zhang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Zhen-Zhou Jiang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing 210009, China.
| |
Collapse
|
47
|
Dumitrascu OM, Lamb J, Lyden PD. Still cooling after all these years: Meta-analysis of pre-clinical trials of therapeutic hypothermia for acute ischemic stroke. J Cereb Blood Flow Metab 2016; 36:1157-64. [PMID: 27089911 PMCID: PMC4929706 DOI: 10.1177/0271678x16645112] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
Abstract
Therapeutic hypothermia is the most potent neuroprotectant for experimental cerebral ischemia, illustrated in a 2007 meta-analysis published in this journal. To address recent therapeutic nihilism, we systematically reviewed recent experimental literature. Quality scoring showed considerable improvement in study design. Using several outcome measures in a variety of models and species, therapeutic hypothermia was protective compared with normothermia, with powerful and statistically significant normalized treatment effect sizes, in 60 papers comprising 216 comparisons. In the past 5 years, preclinical studies of ischemic stroke re-emphasize that therapeutic hypothermia is potently effective, justifying further development in larger human clinical trials.
Collapse
Affiliation(s)
- Oana M Dumitrascu
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Jessica Lamb
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Patrick D Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| |
Collapse
|
48
|
A systematic review and meta-analysis of the ability of analgesic drugs to reduce metastasis in experimental cancer models. Pain 2016; 156:1835-1844. [PMID: 26181303 PMCID: PMC4770345 DOI: 10.1097/j.pain.0000000000000296] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Supplemental Digital Content is Available in the Text. Analgesics are commonly used to manage pain in cancer patients. It has been suggested that there might be a relation between analgesics and the outgrowth of metastases. Opioids might increase and non-steroidal anti-inflammatory drugs decrease the risk of metastasis. Robust analysis of all preclinical evidence, however, has so far been lacking. Therefore, we conducted a systematic review and meta-analysis on the effect of treatment with analgesics on metastasis in experimental animal models. One hundred forty-seven studies met the inclusion criteria. Study characteristics, outcome data on the number, and incidence of metastases were extracted, and methodological quality was assessed. In the meta-analysis, we included 215 (±4000 animals) and 137 (±3000 animals) comparisons between analgesic vs control treatment, respectively, on the number and incidence of metastases. Overall, treatment with analgesics significantly decreases the number and risk of metastasis. This effect appears mainly to be the consequence of the efficacy of NSAIDs. Other factors that modify the efficacy are species, type of NSAIDs administered, timing, and duration of treatment. There is no evidence indicating that treatment with any analgesics increases the occurrence of metastases. Our findings appear robust for the various animal models and designs included in this review, which increases our confidence in the result and translatability to the clinical situation.
Collapse
|
49
|
Wang B, Wu D, Dornbos III D, Shi J, Ma Y, Zhang M, Liu Y, Chen J, Ding Y, Luo Y, Ji X. Local cerebral hypothermia induced by selective infusion of cold lactated ringer’s: a feasibility study in rhesus monkeys. Neurol Res 2016; 38:545-52. [DOI: 10.1080/01616412.2016.1187827] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
50
|
Lee JH, Wei L, Gu X, Won S, Wei ZZ, Dix TA, Yu SP. Improved Therapeutic Benefits by Combining Physical Cooling With Pharmacological Hypothermia After Severe Stroke in Rats. Stroke 2016; 47:1907-13. [PMID: 27301934 PMCID: PMC4927220 DOI: 10.1161/strokeaha.116.013061] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Therapeutic hypothermia is a promising strategy for treatment of acute stroke. Clinical translation of therapeutic hypothermia, however, has been hindered because of the lack of efficiency and adverse effects. We sought to enhance the clinical potential of therapeutic hypothermia by combining physical cooling (PC) with pharmacologically induced hypothermia after ischemic stroke. Methods— Wistar rats were subjected to 90-minute middle cerebral artery occlusion by insertion of an intraluminal filament. Mild-to-moderate hypothermia was induced 120 minutes after the onset of stroke by PC alone, a neurotensin receptor 1 (NTR1) agonist HPI-201 (formally ABS-201) alone or the combination of both. The outcomes of stroke were evaluated at 3 and 21 days after stroke. Results— PC or HPI-201 each showed hypothermic effect and neuroprotection in stroke rats. The combination of PC and HPI-201 exhibited synergistic effects in cooling process, reduced infarct formation, cell death, and blood-brain barrier damages and improved functional recovery after stroke. Importantly, coapplied HPI-201 completely inhibited PC-associated shivering and tachycardia. Conclusions— The centrally acting hypothermic drug HPI-201 greatly enhanced the efficiency and efficacy of conventional PC; this combined cooling therapy may facilitate clinical translation of hypothermic treatment for stroke.
Collapse
Affiliation(s)
- Jin Hwan Lee
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Ling Wei
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Xiaohuan Gu
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Soonmi Won
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Zheng Zachory Wei
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Thomas A Dix
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.)
| | - Shan Ping Yu
- From the Departments of Anesthesiology (J.H.L., L.W., X.G., S.W., Z.Z.W., S.P.Y.) and Neurology (L.W.), Emory University School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA (J.H.L., L.W., X.G., Z.Z.W., S.P.Y.); JT Pharmaceuticals, Mt. Pleasant, SC (T.A.D.); and Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston (T.A.D.).
| |
Collapse
|