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Wang PF, Zhou Y, Fang H, Lin S, Wang YC, Liu Y, Xia J, Eslick GD, Yang QW. Treatment of acute cerebral ischemia using animal models: a meta-analysis. Transl Neurosci 2015; 6:47-58. [PMID: 28123790 PMCID: PMC4936615 DOI: 10.1515/tnsci-2015-0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/11/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There are numerous potential treatments assessed for acute cerebral ischemia using animal models. This study aimed to assess the effect of these treatments in terms of infarct size and neurobehavioral change. This meta-analysis was conducted to determine if any of these treatments provide a superior benefit so that they might be used on humans. METHODS A systematic search was conducted using several electronic databases for controlled animal studies using only nonsurgical interventions for acute cerebral ischemia. A random-effects model was used. RESULTS After an extensive literature search, 145 studies were included in the analysis. These studies included 1408 treated animals and 1362 control animals. Treatments that had the most significant effect on neurobehavioral scales included insulin, various antagonists, including N-methyl-D-aspartate (NMDA) receptor antagonist ACEA1021, calmodulin antagonist DY-9760e, and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist YM872, and antiviral agents. Treatments providing the greatest effect on infarct size included statins, sphingosine-1-phosphate agonist (fingolimod), alcohol, angiotensin, and leukotrienes. Treatments offering the greatest reduction in brain water content included various agonists, including sphingosine-1-phosphate agonist fingolimod, statins, and peroxisome proliferator-activated receptor gamma (PPAR-γ). Treatment groups with more than one study all had high heterogeneity (I2 > 80%), however, using meta-regression we determined several sources of heterogeneity including sample size of the treatment and control groups, the occlusion time, but not the year when the study was conducted. CONCLUSIONS Some treatments stand out when compared to others for acute cerebral ischemia in animals. Greater replication of treatment studies is required before any treatments are selected for future human trials.
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Affiliation(s)
- Peng-Fei Wang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, The Third Military Medical University, Chongqing, China
| | - Yu Zhou
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, The Third Military Medical University, Chongqing, China
| | - Huang Fang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, The Third Military Medical University, Chongqing, China
| | - Sen Lin
- Department of Development and Regeneration Key Laboratory of Sichuan Province, Department of Histoembryology and Neurobiology, Chengdu Medical College, Chengdu, China
| | - Yan-Chun Wang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, The Third Military Medical University, Chongqing, China
| | - Yong Liu
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, The Third Military Medical University, Chongqing, China
| | - Jun Xia
- Systematic Review Solutions, China
| | - Guy D Eslick
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, Australia
| | - Qing-Wu Yang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, The Third Military Medical University, Chongqing, China
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Smith CJ, Lawrence CB, Rodriguez-Grande B, Kovacs KJ, Pradillo JM, Denes A. The immune system in stroke: clinical challenges and their translation to experimental research. J Neuroimmune Pharmacol 2013; 8:867-87. [PMID: 23673977 DOI: 10.1007/s11481-013-9469-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/28/2013] [Indexed: 12/27/2022]
Abstract
Stroke represents an unresolved challenge for both developed and developing countries and has a huge socio-economic impact. Although considerable effort has been made to limit stroke incidence and improve outcome, strategies aimed at protecting injured neurons in the brain have all failed. This failure is likely to be due to both the incompleteness of modelling the disease and its causes in experimental research, and also the lack of understanding of how systemic mechanisms lead to an acute cerebrovascular event or contribute to outcome. Inflammation has been implicated in all forms of brain injury and it is now clear that immune mechanisms profoundly influence (and are responsible for the development of) risk and causation of stroke, and the outcome following the onset of cerebral ischemia. Until very recently, systemic inflammatory mechanisms, with respect to common comorbidities in stroke, have largely been ignored in experimental studies. The main aim is therefore to understand interactions between the immune system and brain injury in order to develop novel therapeutic approaches. Recent data from clinical and experimental research clearly show that systemic inflammatory diseases -such as atherosclerosis, obesity, diabetes or infection - similar to stress and advanced age, are associated with dysregulated immune responses which can profoundly contribute to cerebrovascular inflammation and injury in the central nervous system. In this review, we summarize recent advances in the field of inflammation and stroke, focusing on the challenges of translation between pre-clinical and clinical studies, and potential anti-inflammatory/immunomodulatory therapeutic approaches.
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Affiliation(s)
- Craig J Smith
- Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford M6 8HD, UK.
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Doi H, Kamikonya N, Takada Y, Niwa Y, Fujiwara M, Tsuboi K, Miura H, Inoue H, Tanooka M, Nakamura T, Shikata T, Kimura T, Tsujimura T, Hirota S. Low-Dose Aspirin Therapy Does not Increase the Severity of Acute Radiation Proctitis. World J Oncol 2012; 3:173-181. [PMID: 29147301 PMCID: PMC5649840 DOI: 10.4021/wjon559w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 02/02/2023] Open
Abstract
Background Although anticoagulation therapy is commonly used in the prostate cancer population, there are only a few studies about the correlation between radiation proctitis and anticoagulation therapy. The purpose of the present study was to determine whether low-dose aspirin increases the severity of acute radiation proctitis in an experimental animal model. Methods Wistar rats were used in the present study. The rats were administered either aspirin at doses of 5, 10, and 20 mg/kg, or saline, daily before and after irradiation. The rats were irradiated to the rectum as a single fraction of 25 Gy. The rectal mucosal changes of each rat were evaluated macroscopically and pathologically on the tenth day following irradiation. The findings of proctitis were graded from 0 to 4, and then were compared with regard to the status. Results No apparent correlations were observed between the administration of aspirin and the severity of radiation proctitis in the macroscopic findings and in the morphological mucosal damage in the pathological examination. The proportion of rats with a severe degree of mucosal inflammation was 90.0%, 100.0%, 16.7% and 100.0% at 5 mg/kg, 10 mg/kg, and 20 mg/kg of aspirin, or saline, respectively. The rats receiving aspirin at the dose of 20 mg/kg showed significantly milder inflammation than the other groups (P < 0.05). Conclusions In the present study, low-dose aspirin did not increase the severity of acute radiation proctitis. In addition, aspirin might decrease the severity of radiation-induced mucosal inflammation in the rectum.
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Affiliation(s)
- Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Norihiko Kamikonya
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Yasuhiro Takada
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Yasue Niwa
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Masayuki Fujiwara
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Keita Tsuboi
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Hideharu Miura
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Hiroyuki Inoue
- Department of Clinical Radiology, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Masao Tanooka
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Takeshi Nakamura
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Toshiyuki Shikata
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Tohru Tsujimura
- Department of Pathology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
| | - Shozo Hirota
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, Japan
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Schoeman JF, Janse van Rensburg A, Laubscher JA, Springer P. The role of aspirin in childhood tuberculous meningitis. J Child Neurol 2011; 26:956-62. [PMID: 21628697 DOI: 10.1177/0883073811398132] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial stroke is the main cause of poor outcome in childhood tuberculous meningitis. Aspirin has an antithrombotic action at low dose and anti-ischemic and anti-inflammatory properties, which are dose-related. The aim of the study was to explore the possible benefits of aspirin in children with tuberculous meningitis. A total of 146 consecutive children with a diagnosis of probable tuberculous meningitis were studied. Patients were randomized into 3 groups: (1) placebo group, (2) low-dose aspirin group, and (3) high-dose aspirin group. Twenty-nine additional patients who received aspirin before admission were excluded from the randomized study, but continued on low-dose aspirin. Aspirin, irrespective of dose, did not show any significant benefit regarding morbidity (hemiparesis and developmental outcome) and mortality. Aspirin was well tolerated, but 1 death was probably related to aspirin. The fact that the outcome of the high-dose aspirin group compared favorably with the other treatment groups despite younger age and more severe neurological involvement at baseline needs further investigation.
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Affiliation(s)
- Johan F Schoeman
- Department of Pediatrics and Child Health, Tygerberg Children's Hospital Faculty of Health Sciences, Stellenbosch University, South Africa.
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