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Gharios M, Stenimahitis V, El-Hajj VG, Mahdi OA, Fletcher-Sandersjöö A, Jabbour P, Andersson M, Hultling C, Elmi-Terander A, Edström E. Spontaneous spinal cord infarction: a systematic review. BMJ Neurol Open 2024; 6:e000754. [PMID: 38818241 PMCID: PMC11138300 DOI: 10.1136/bmjno-2024-000754] [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: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
Background and objectives Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes. Methods The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords 'spontaneous', 'spinal cord', 'infarction' and 'ischaemic'. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted and systematically analysed. Results 440 patients from 33 studies were included in this systematic review. Analysis of vascular risk factors showed that hypertension was present in 40%, followed by smoking in 30%, dyslipidaemia in 29% and diabetes in 16%. The severity of symptoms at admission according to the American Spinal Injury Association (ASIA) Impairment Scale was score A 19%, score B14%, score C36% and score D32%. The mean follow-up period was 34.8 (±12.2) months. ASIA score at follow-up showed score A 11%, score B 3%, score C 16%, score D 67% and score E 2%. The overall mortality during the follow-up period was 5%. When used, MRI with diffusion-weighted imaging (DWI) supported the diagnosis in 81% of cases. At follow-up, 71% of the patients were able to walk with or without walking aids. Conclusion The findings suggest a significant role for vascular risk factors in the pathophysiology of spontaneous SCInf. In the diagnostic workup, the use of DWI along with an MRI may help in confirming the diagnosis. The findings at follow-up suggest that neurological recovery is to be expected, with the majority of patients regaining ambulation. This systematic review highlights gaps in the literature and underscores the necessity for further research to establish diagnostic criteria and treatment guidelines.
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Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Vasilios Stenimahitis
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Rehabilitation, Furuhöjden Rehab Hospital, Täby, Sweden
| | | | - Omar Ali Mahdi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Magnus Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
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2
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Wan M, Yang K, Zhang G, Yang C, Wei Y, He Y, Jiang X. Efficacy, safety, and cost-effectiveness analysis of Cerebrolysin in acute ischemic stroke: A rapid health technology assessment. Medicine (Baltimore) 2024; 103:e37593. [PMID: 38552072 PMCID: PMC10977584 DOI: 10.1097/md.0000000000037593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
This study conducts a rapid health technology assessment to systematically evaluate the effectiveness, safety, and cost-effectiveness of Cerebrolysin as an adjunctive therapy for acute ischemic stroke to provide evidence-based medicine for clinical decisions of Cerebrolysin. All systematic reviews/meta-analyses, pharmacoeconomic studies, and health technology assessment reports of Cerebrolysin for the treatment of acute ischemic stroke before August 17, 2023, were retrieved from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Weipu, Sinomed database and the official website of health technology assessment. According to the inclusion and exclusion criteria, 2 researchers independently carried out screening, data extraction, and quality evaluation and descriptively analyzed the results of the included studies. A total of 14 pieces of literature were incorporated, comprising 8 systematic reviews/meta-analyses and 6 pharmacoeconomic studies. In terms of effectiveness, compared to control groups, the use of Cerebrolysin as a treatment for acute ischemic stroke demonstrates certain advantages, including enhancement in total efficacy rate, neurological function, upper limb motor dysfunction, and facilitation of the recovery of activities of daily living. Especially in patients with moderate to severe acute ischemic stroke, Cerebrolysin has demonstrated the ability to enhance neurological function recovery and ameliorate disabilities. Regarding safety, adverse reactions were mild or comparable to those in the control group. The primary findings of economic studies reveal that advocating for the use of Cerebrolysin offers certain cost-effectiveness advantages. Cerebrolysin contributes to improved clinical efficacy and evaluation indexes while demonstrating favorable safety and economic benefits.
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Affiliation(s)
- Miaomiao Wan
- Department of Clinical Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ke Yang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Gonghao Zhang
- College of First Clinical Medical, Guangxi Medical University, Nanning, China
| | - Chunxia Yang
- College of Pharmacy, Guangxi Medical University, Nanning, China
| | - Yuqing Wei
- College of Pharmacy, Guangxi Medical University, Nanning, China
| | - Yeqian He
- College of Pharmacy, Guangxi Medical University, Nanning, China
| | - Xia Jiang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Lanzone J, Zulueta A, Boscarino M, Gallotta M, Argentieri MR, Viganò A, Sarasso S, Colombo MA, D’Ambrosio S, Lunetta C, Parati E. Spectral exponent assessment and neurofilament light chain: a comprehensive approach to describe recovery patterns in stroke. Front Neurol 2024; 15:1329044. [PMID: 38562428 PMCID: PMC10982436 DOI: 10.3389/fneur.2024.1329044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Understanding the residual recovery potential in stroke patients is crucial for tailoring effective neurorehabilitation programs. We propose using EEG and plasmatic Neurofilament light chain (NfL) levels as a model to depict longitudinal patterns of stroke recovery. Methods We enrolled 13 patients (4 female, mean age 74.7 ± 8.8) who underwent stroke in the previous month and were hospitalized for 2-months rehabilitation. Patients underwent blood withdrawal, clinical evaluation and high-definition EEG at T1 (first week of rehabilitation) and at T2 (53 ± 10 days after). We assessed the levels of NfL and we analyzed the EEG signal extracting Spectral Exponent (SE) values. We compared our variables between the two timepoint and between cortical and non-cortical strokes. Results We found a significant difference in the symmetry of SE values between cortical and non-cortical stroke at both T1 (p = 0.005) and T2 (p = 0.01). SE in the affected hemisphere showed significantly steeper values at T1 when compared with T2 (p = 0.001). EEG measures were consistently related to clinical scores, while NfL at T1 was related to the volume of ischemic lesions (r = 0.75; p = 0.003). Additionally, the combined use of NfL and SE indicated varying trends in longitudinal clinical recovery. Conclusion We present proof of concept of a promising approach for the characterization of different recovery patterns in stroke patients.
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Affiliation(s)
- Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Marilisa Boscarino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Matteo Gallotta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Maria Rosaria Argentieri
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | | | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Michele A. Colombo
- Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Sasha D’Ambrosio
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Milan, Italy
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - Eugenio Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
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Zhang S, Zhao J, Sha WM, Zhang XP, Mai JY, Bartlett PF, Hou ST. Inhibition of EphA4 reduces vasogenic edema after experimental stroke in mice by protecting the blood-brain barrier integrity. J Cereb Blood Flow Metab 2024; 44:419-433. [PMID: 37871622 PMCID: PMC10870966 DOI: 10.1177/0271678x231209607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/07/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023]
Abstract
Cerebral vasogenic edema, a severe complication of ischemic stroke, aggravates neurological deficits. However, therapeutics to reduce cerebral edema still represent a significant unmet medical need. Brain microvascular endothelial cells (BMECs), vital for maintaining the blood-brain barrier (BBB), represent the first defense barrier for vasogenic edema. Here, we analyzed the proteomic profiles of the cultured mouse BMECs during oxygen-glucose deprivation and reperfusion (OGD/R). Besides the extensively altered cytoskeletal proteins, ephrin type-A receptor 4 (EphA4) expressions and its activated phosphorylated form p-EphA4 were significantly increased. Blocking EphA4 using EphA4-Fc, a specific and well-tolerated inhibitor shown in our ongoing human phase I trial, effectively reduced OGD/R-induced BMECs contraction and tight junction damage. EphA4-Fc did not protect OGD/R-induced neuronal and astrocytic death. However, administration of EphA4-Fc, before or after the onset of transient middle cerebral artery occlusion (tMCAO), reduced brain edema by about 50%, leading to improved neurological function recovery. The BBB permeability test also confirmed that cerebral BBB integrity was well maintained in tMCAO brains treated with EphA4-Fc. Therefore, EphA4 was critical in signaling BMECs-mediated BBB breakdown and vasogenic edema during cerebral ischemia. EphA4-Fc is promising for the treatment of clinical post-stroke edema.
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Affiliation(s)
- Shuai Zhang
- Brain Research Centre, Department of Biology, School of Life Science, Southern University of Science and Technology, Shenzhen, P. R. China
| | - Jing Zhao
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Wei-Meng Sha
- Brain Research Centre, Department of Biology, School of Life Science, Southern University of Science and Technology, Shenzhen, P. R. China
| | - Xin-Pei Zhang
- Brain Research Centre, Department of Biology, School of Life Science, Southern University of Science and Technology, Shenzhen, P. R. China
| | - Jing-Yuan Mai
- Brain Research Centre, Department of Biology, School of Life Science, Southern University of Science and Technology, Shenzhen, P. R. China
| | - Perry F Bartlett
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Sheng-Tao Hou
- Brain Research Centre, Department of Biology, School of Life Science, Southern University of Science and Technology, Shenzhen, P. R. China
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5
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Amalia L. Does the Implementation of a National Health Insurance Program Result in Rationing Care for Ischemic Stroke Management? Analysis of the Indonesian National Health Insurance Program. Risk Manag Healthc Policy 2023; 16:455-461. [PMID: 37007298 PMCID: PMC10065421 DOI: 10.2147/rmhp.s405986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background There are 2.2 million stroke patients in Indonesia, and ischemic stroke represents 87% of all strokes. Ischemic stroke is one of the covered diseases (INA-CBGs) in the National Health Insurance (JKN). Based on the Indonesian Ministry of Health's data, stroke uses up 1% of the yearly budget. This study compares clinical outcomes and treatment patterns before and during the JKN era. Methods A cross-sectional analytical study of ischemic stroke medical records treated at Hasan Sadikin Hospital in 2013 and 2015 as representatives of the before and during JKN era. Chi-Square is used for data processing relationship analysis. Results 164 ischemic stroke patients were treated, 75 before implementing the JKN program and 89 after implementing the JKN program. There was a significant difference between treatment patterns (p<0.001) and clinical outcomes (p=0.046) of ischemic stroke patients before and after implementing The Indonesian National Health Insurance. There was no significant difference in length of stay (LOS). Conclusion There is significant different between treatment pattern and clinical outcome of ischemic stroke patients before and after implementing The Indonesian National Health Insurance. This program has improved clinical outcomes concerning the purpose of the JKN program to provide social protection and welfare in terms of health.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Correspondence: Lisda Amalia, Department of Neurology, Faculty of Medicine, Universitas Padjadjaran, Jl. Eykman 38, Bandung, 40161, Indonesia, Email
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Karkra R, Jain R, Shivaswamy RP. Recurrent Strokes in a Patient With Metastatic Lung Cancer. Cureus 2023; 15:e34699. [PMID: 36909080 PMCID: PMC9995248 DOI: 10.7759/cureus.34699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/08/2023] Open
Abstract
A stroke, also known as cerebrovascular accident (CVA), is a medical condition that occurs when the blood supply to the brain is interrupted, resulting in brain cell death. Cancer-associated stroke (CAS) is a rare but serious complication of cancer, where a malignant tumor or its metastases invade or compress the blood vessels in the brain, resulting in a stroke. We describe a case of a 60-year-old male patient recently diagnosed with lung cancer with metastasis to the liver, esophagus, small intestine, and pancreas who has had at least three CVAs within a span of three months. He developed sequelae such as hemiplegia and aphasia. He was managed with dual antiplatelet therapy, neuroprotective drugs, and physiotherapy. Patients with advanced cancers should be routinely screened for neurovascular complications and risks. Prophylactic therapy should be started wherever warranted.
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Affiliation(s)
- Rohan Karkra
- Medicine, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSSAHER (JSS Academy of Higher Education and Research), Mysuru, IND
| | - Riya Jain
- Medicine, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSSAHER (JSS Academy of Higher Education and Research), Mysuru, IND
| | - Rajendra P Shivaswamy
- Internal Medicine, JSS (Jagadguru Sri Shivarathreeshwara) Medical College and Hospital, JSSAHER (JSS Academy of Higher Education and Research), Mysuru, IND
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7
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The effect of citicoline oral solution on quality of life in patients with glaucoma: the results of an international, multicenter, randomized, placebo-controlled cross-over trial. Graefes Arch Clin Exp Ophthalmol 2023; 261:1659-1668. [PMID: 36639525 DOI: 10.1007/s00417-022-05947-5] [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: 09/14/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE This study aims to evaluate whether the use of citicoline oral solution could improve quality of life in patients with chronic open-angle glaucoma (OAG). DESIGN Randomized, double-masked, placebo-controlled, cross-over study was used. Patients were randomized to one of the two sequences: either citicoline 500 mg/day oral solution-placebo or placebo-citicoline 500 mg/day oral solution. Switch of treatments was done after 3 months; patients were then followed for other 6 months. Follow-up included 3-month, 6-month, and 9-month visits. OUTCOMES The primary outcome was the mean change of "intra-patient" composite score of the Visual Function Questionnaire-25 (VFQ-25). after citicoline oral solution vs placebo at 6-month visit as compared with baseline. METHODS The trial was multicenter, conducted at 5 European Eye Clinics. OAG patients with bilateral visual field damage, a mean deviation (MD) ranging from - 5 to - 13 dB in the better eye, and controlled IOP were included. VFQ-25 and SF-36 questionnaires were administered at baseline and at 3-, 6-, and 9-month visits. A mixed effect model, with a random effect on the intercept, accounted for correlations among serial measurements on each subject. RESULTS The primary pre-specified outcome of the analysis reached statistical significance (p = 0.0413), showing greater improvement after citicoline oral solution. There was an increase in the composite score in both arms compared to baseline, but it was significant only for the placebo-citicoline arm (p = 0.0096, p = 0.0007, and p = 0.0006 for the three time-points compared to baseline). The effect of citicoline was stronger in patients with vision-related quality of life more affected by glaucoma at baseline. CONCLUSIONS This is the first placebo-controlled clinical study evaluating the effect of a medical treatment aiming at improving vision-related quality of life in glaucomatous patients.
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Su Z, Zhang S, Yu Z, Jin H, Sun W, Yang Z, Zhao D. Efficacy and safety of blood-activating herbs combined with edaravone in the treatment of acute ischemic stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32162. [PMID: 36482528 PMCID: PMC9726419 DOI: 10.1097/md.0000000000032162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although the combination of blood-activating herbs and western drugs has shown advantages in the treatment of ischemic stroke, there is no consensus on the safety and efficacy. This study aimed to systematically evaluate the safety and efficacy of the combination of blood-activating herbs with edaravone (EDA) in the treatment of acute ischemic stroke (AIS). METHODS We will implement the search strategy in 8 English and Chinese databases: Cochrane Central Register of Controlled Trials, Web of Science, PubMed, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, EMBASE and MEDLINE. The search included relevant clinical randomized controlled trials and quasi-randomized controlled trials that had been registered for publication by November 2022. Literature screening, data extraction and quality assessment will be performed by 2 authors. We will assess the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method classification will be used to assess the quality of the literature. Meta-analysis was performed using RevMan V.5.4 and STATA 16 software. RESULTS This study will provide a comprehensive analysis of the current clinical evidence on the application of blood-activating herbs combined with EDA in the treatment of AIS. CONCLUSION This study will clarify the safety and efficacy of the combination of blood-activating herbs with EDA in the treatment of AIS.
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Affiliation(s)
- Zhuoyi Su
- Department of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Shuai Zhang
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Ziqiao Yu
- Department of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Hong Jin
- Department of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Weichen Sun
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun, China
| | - Ziqi Yang
- Department of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Dexi Zhao
- Department of Internal Medicine, Division of Brain Diseases, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
- * Correspondence: Dexi Zhao, Department of Internal Medicine, Division of Brain Diseases, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130021, China (e-mail: )
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9
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Secades JJ, Gareri P. Citicoline: pharmacological and clinical review, 2022 update. Rev Neurol 2022; 75:S1-S89. [PMID: 36544369 PMCID: PMC10548481 DOI: 10.33588/rn.75s05.2022311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 12/24/2022]
Abstract
This review is based on the previous one published in 2016 (Secades JJ. Citicoline: pharmacological and clinical review, 2016 update. Rev Neurol 2016; 63 (Supl 3): S1-S73), incorporating 176 new references, having all the information available in the same document to facilitate the access to the information in one document. This review is focused on the main indications of the drug, as acute stroke and its sequelae, including the cognitive impairment, and traumatic brain injury and its sequelae. There are retrieved the most important experimental and clinical data in both indications.
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Affiliation(s)
- Julio J. Secades
- Medical Department. Grupo Ferrer, S.A.
Barcelona, SpainMedical DepartmentGrupo Ferrer, S.A.BarcelonaSpain
| | - Pietro Gareri
- Center for Cognitive Disorders and Dementia -
Catanzaro Lido. ASP Catanzaro. Catanzaro, ItalyCenter for Cognitive Disorders and Dementia -
Catanzaro LidoCenter for Cognitive Disorders and Dementia -
Catanzaro LidoCatanzaroItaly
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10
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Huang SS, Su HH, Chien SY, Chung HY, Luo ST, Chu YT, Wang YH, MacDonald IJ, Lee HH, Chen YH. Activation of peripheral TRPM8 mitigates ischemic stroke by topically applied menthol. J Neuroinflammation 2022; 19:192. [PMID: 35897101 PMCID: PMC9327358 DOI: 10.1186/s12974-022-02553-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 07/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background No reports exist as to neuroprotective effects associated with topical activation of transient receptor potential melastatin 8 (TRPM8), a noted cold receptor. In the present study, we identified whether activating peripheral TRPM8 can be an adjuvant therapy for ischemic stroke.
Methods Menthol, an agonist of TRPM8, was applied orally or topically to all paws or back of the mouse after middle cerebral artery occlusion (MCAO). We used Trpm8 gene knockout (Trpm8−/−) mice or TRPM8 antagonist and lidocaine to validate the roles of TRPM8 and peripheral nerve conduction in menthol against ischemic stroke. Results Application of menthol 16% to paw derma attenuated infarct volumes and ameliorated sensorimotor deficits in stroke mice induced by MCAO. The benefits of topically applied menthol were associated with reductions in oxidative stress, neuroinflammation and infiltration of monocytes and macrophages in ischemic brains. Antagonizing TRPM8 or Trpm8 knockout dulls the neuroprotective effects of topically application of menthol against MCAO. Immunohistochemistry analyses revealed significantly higher TRPM8 expression in skin tissue samples obtained from the paws compared with skin from the backs, which was reflected by significantly smaller infarct lesion volumes and better sensorimotor function in mice treated with menthol on the paws compared with the back. Blocking conduction of peripheral nerve in the four paws reversed the neuroprotective effects of topical menthol administrated to paws. On the other hand, oral menthol dosing did not assist with recovery from MCAO in our study. Conclusion Our results suggested that activation of peripheral TRPM8 expressed in the derma tissue of limbs with sufficient concentration of menthol is beneficial to stroke recovery. Topical application of menthol on hands and feet could be a novel and simple-to-use therapeutic strategy for stroke patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02553-4.
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Affiliation(s)
- Shiang-Suo Huang
- Department of Pharmacology, Chung Shan Medical University, Taichung, 40201, Taiwan.,School of Medicine, Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan
| | - Hsing-Hui Su
- Department of Pharmacology, Chung Shan Medical University, Taichung, 40201, Taiwan.,Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan
| | - Szu-Yu Chien
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan
| | - Hsin-Yi Chung
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan
| | - Sih-Ting Luo
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan
| | - Yu-Ting Chu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan
| | - Yi-Hsin Wang
- Department of Pharmacology, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Iona J MacDonald
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan
| | - Hsun-Hua Lee
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan. .,Dizziness and Balance Disorder Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan. .,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan. .,Department of Neurology, Taipei Medical University Hospital, Taipei Medical University, Taipei, 11031, Taiwan.
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, 40402, Taiwan. .,Chinese Medicine Research Center, China Medical University, Taichung, 40402, Taiwan. .,Department of Computer Science and Information Engineering, Asia University, Wufeng, Taichung, 41354, Taiwan.
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11
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Fidalgo M, Ricardo Pires J, Viseu I, Magalhães P, Gregório H, Afreixo V, Gregório T. Edaravone for acute ischemic stroke - Systematic review with meta-analysis. Clin Neurol Neurosurg 2022; 219:107299. [PMID: 35753163 DOI: 10.1016/j.clineuro.2022.107299] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ischemic stroke is a major cause of death and disability. Despite major advances in reperfusion therapies, most patients don´t benefit from these treatments as the time window for such interventions is limited. Therefore, other treatment options are desirable. Edaravone has been demonstrated in previous studies to reduce neurologic deficits in stroke patients. OBJECTIVE To test the hypothesis that edaravone reduces functional dependence in ischemic stroke patients. MATERIAL AND METHODS Systematic review and meta-analysis of randomized controlled trials and observational studies comparing edaravone to placebo in adult patients with ischemic stroke. The efficacy outcomes of interest were good and excellent functional outcomes at 90 days, defined as modified Rankin Scale (mRS) scores of 0-2 and 0-1 respectively. The safety outcomes of interest were intracranial hemorrhage and mortality. RESULTS 19 studies were included. Edaravone treatment was associated with improved chances of 90-day good (OR=1.31, 95% CI 1.06-1.67) and excellent (OR=1.26, 95% CI 1.04-1.54) functional outcomes. Mortality was also lower in edaravone treated patients (OR=0.50, 95% CI 0.45-0.56). There were no differences in terms of intracranial hemorrhage. Most studies were observational and performed in Asian populations, especially Japan. Heterogeneity was high for all outcomes but reduced when analysis was restricted to randomized trials. CONCLUSION Edaravone is a promising treatment for ischemic stroke patients, with a more favorable time window. However, more randomized studies including patient populations outside Asia are required to confirm this hypothesis.
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Affiliation(s)
- Mariana Fidalgo
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia e Espinho, R. Conceição Fernandes S/N, Vila Nova de Gaia 4434-502, Portugal.
| | - Joana Ricardo Pires
- Department of Internal Medicine, Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, Aveiro 3810-164, Portugal; Centre for Research and Development in Mathematics and Applications, University of Aveiro (Universidade de Aveiro), Aveiro 3810-193, Portugal
| | - Inês Viseu
- Centre for Research and Development in Mathematics and Applications, University of Aveiro (Universidade de Aveiro), Aveiro 3810-193, Portugal
| | - Pedro Magalhães
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia e Espinho, R. Conceição Fernandes S/N, Vila Nova de Gaia 4434-502, Portugal
| | - Hugo Gregório
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Quinta de Prados, Edificio Reitoria, Room D2.30, Vila Real 5000-801, Portugal
| | - Vera Afreixo
- Centre for Research and Development in Mathematics and Applications, University of Aveiro (Universidade de Aveiro), Aveiro 3810-193, Portugal
| | - Tiago Gregório
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia e Espinho, R. Conceição Fernandes S/N, Vila Nova de Gaia 4434-502, Portugal; Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
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12
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Tran L, Alvarez XA, Le HA, Nguyen DA, Le T, Nguyen N, Nguyen T, Nguyen T, Vo T, Tran T, Duong C, Nguyen H, Nguyen S, Nguyen H, Le T, Nguyen M, Nguyen T. Clinical Efficacy of Cerebrolysin and Cerebrolysin plus Nootropics in the Treatment of Patients with Acute Ischemic Stroke in Vietnam. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:621-630. [PMID: 34414874 DOI: 10.2174/1871527320666210820091655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 01/13/2023]
Abstract
AIMS To investigate the efficacy and safety of Cerebrolysin and Cerebrolysin plus nootropics in the routine treatment of patients with acute ischemic stroke (AIS). BACKGROUND Acute ischemic stroke (AIS) is a leading cause of disability with unmet treatment needs lacking effective drug therapy. Multimodal drugs modulating stroke pathophysiology as Cerebrolysin constitute a good therapeutic option. OBJECTIVE In this study, we assessed the effects of Cerebrolysin and Cerebrolysin plus nootropics, in comparison with other nootropic drugs alone, on functional, neurological and cognitive recovery of patients with AIS in Vietnam. METHODS This non-interventional, controlled, open-label, prospective and multicenter study included 398 AIS patients (234 males) treated with Cerebrolysin (n=190; 20 i.v. infusions of 10 ml), other nootropics (comparator group; n=86), or a combination of both (n=122). The study primary endpoint was the modified Ranking Scale (mRS) score on day 90. Secondary endpoints included study-period change in NIHSS score; percentage of well-recovered (mRS 0-2) patients, the proportion of good NIHSS response (≥6 points) cases, and MoCA scores at day 90; and safety indicators. RESULTS Compared with other nootropics, both Cerebrolysin and combined therapy induced significant improvements (p<0.001) in: Functional recovery (mRS scores); percentage of well-recovered patients (Cerebrolysin: 81.6%; combination: 93.4%; comparator: 43.0%); neurological recovery (study- period NIHSS change); proportion of good NIHSS responders (Cerebrolysin: 77.5%; combination: 92.5%; comparator: 47.6%); and MoCA scores (Cerebrolysin: 23.3±4.8; combination: 23.7±4.1; comparator: 15.9±7.7). Compared to Cerebrolysin, combined therapy improved (p<0.01) mRS outcomes and NIHSS change, but not MoCA scores, in moderate-severe stroke (NIHSS>11) cases only. No drug-related adverse events were reported. CONCLUSION Cerebrolysin alone or combined with other nootropics was effective and safe in routine AIS treatment, during both acute and recovery phases, which supports its use in daily clinical practice. Others: According to the results of this multicenter study, the importance of reducing differences in the treatment regimens of AIS in Vietnam should be further emphasized.
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Affiliation(s)
- Luc Tran
- Outpatient Department, National Geriatric Hospital, Hanoi, Vietnam
| | - X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain.,Clinical Research Department, QPS Holdings, A Coruña, Spain
| | | | | | - Thinh Le
- Neurology Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Nguyen
- Stroke centre, 108 Military Hospital, Hanoi, Vietnam
| | - Thang Nguyen
- Department of Cerebrovascular Disease, 115 People's Hospital, Hochiminh City, Vietnam
| | - Tai Nguyen
- Neurology Department, Cho Ray Hospital, Hochiminh City, Vietnam
| | - Tan Vo
- Neurology Department, Gia Dinh People's Hospital, Hochiminh City, Vietnam
| | - Tuan Tran
- Neurology Department, Thai Nguyen Central General Hosp, Thainguyen, Vietnam
| | - Chinh Duong
- Neurology Department, Nghe An General Hospital, Nghean, Vietnam
| | - Huyen Nguyen
- Neurology Department, Viet Tiep General Hospital, Haiphong, Vietnam
| | - Sam Nguyen
- Neurology Department, Thanh Hoa General Hospital, Thanhhoa, Vietnam
| | - Hien Nguyen
- Stroke unit, 103 Military Hospital, Hanoi, Vietnam
| | - Thanh Le
- Neurology Department, Thong Nhat Hospital, Hochiminh City, Vietnam
| | - Minh Nguyen
- Neurology Department, Trung Vuong Hospital, Hochiminh City, Vietnam
| | - Thang Nguyen
- Neurology Department, Hochiminh City Medicine and Pharmacy University Hospital, Hochiminh City, Vietnam
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Jasielski P, Piędel F, Piwek M, Rocka A, Petit V, Rejdak K. Application of Citicoline in Neurological Disorders: A Systematic Review. Nutrients 2020; 12:E3113. [PMID: 33053828 PMCID: PMC7601330 DOI: 10.3390/nu12103113] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
Citicoline is a chemical compound involved in the synthesis of cell membranes. It also has other, not yet explained functions. Research on the use of citicoline is conducted in neurology, ophthalmology, and psychiatry. Citicoline is widely available as a dietary supplement. It is often used to enhance cognitive functions. In our article, accessible databases were searched for articles regarding citicoline use in neurological diseases. This article has a systemic review form. After rejecting non-eligible reports, 47 remaining articles were reviewed. The review found that citicoline has been proven to be a useful compound in preventing dementia progression. It also enhances cognitive functions among healthy individuals and improves prognosis after stroke. In an animal model of nerve damage and neuropathy, citicoline stimulated regeneration and lessened pain. Among patients who underwent brain trauma, citicoline has an unclear clinical effect. Citicoline has a wide range of effects and could be an essential substance in the treatment of many neurological diseases. Its positive impact on learning and cognitive functions among the healthy population is also worth noting.
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Affiliation(s)
- Patryk Jasielski
- Department of Neurology, Medical University of Lublin, 20-059 Lublin, Poland; (F.P.); (M.P.); (A.R.); (V.P.); (K.R.)
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14
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Mallah K, Couch C, Borucki DM, Toutonji A, Alshareef M, Tomlinson S. Anti-inflammatory and Neuroprotective Agents in Clinical Trials for CNS Disease and Injury: Where Do We Go From Here? Front Immunol 2020; 11:2021. [PMID: 33013859 PMCID: PMC7513624 DOI: 10.3389/fimmu.2020.02021] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Neurological disorders are major contributors to death and disability worldwide. The pathology of injuries and disease processes includes a cascade of events that often involve molecular and cellular components of the immune system and their interaction with cells and structures within the central nervous system. Because of this, there has been great interest in developing neuroprotective therapeutic approaches that target neuroinflammatory pathways. Several neuroprotective anti-inflammatory agents have been investigated in clinical trials for a variety of neurological diseases and injuries, but to date the results from the great majority of these trials has been disappointing. There nevertheless remains great interest in the development of neuroprotective strategies in this arena. With this in mind, the complement system is being increasingly discussed as an attractive therapeutic target for treating brain injury and neurodegenerative conditions, due to emerging data supporting a pivotal role for complement in promoting multiple downstream activities that promote neuroinflammation and degeneration. As we move forward in testing additional neuroprotective and immune-modulating agents, we believe it will be useful to review past trials and discuss potential factors that may have contributed to failure, which will assist with future agent selection and trial design, including for complement inhibitors. In this context, we also discuss inhibition of the complement system as a potential neuroprotective strategy for neuropathologies of the central nervous system.
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Affiliation(s)
- Khalil Mallah
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
| | - Christine Couch
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Davis M. Borucki
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
- Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, United States
| | - Amer Toutonji
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
- Medical Scientist Training Program, Medical University of South Carolina, Charleston, SC, United States
| | - Mohammed Alshareef
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Department of Neurological Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Stephen Tomlinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
- Ralph Johnson VA Medical Center, Charleston, SC, United States
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15
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Xu D, Li F, Hou K, Gou X, Fang W, Li Y. XQ-1H attenuates ischemic injury in PC12 cells via Wnt/β-catenin signaling though inhibition of apoptosis and promotion of proliferation. Cell Biol Int 2020; 44:2363-2369. [PMID: 32761926 DOI: 10.1002/cbin.11438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/15/2020] [Accepted: 08/01/2020] [Indexed: 01/10/2023]
Abstract
10-O-(N,N-dimethylaminoethyl)-ginkgolide B methanesulfonate (XQ-1H) is a new derivative of ginkgolide B and has previously been proven to exert neuroprotective effects on ischemic injury. However, it is not clear whether XQ-1H affects the cell survival and proliferation in oxygen-glucose deprivation/reoxygenation (OGD/R) damaged PC12 cells. Our results showed that OGD/R improved cell viability after 24 hr of posttreatment with XQ-1H (10 or 5 μM), inhibiting cell injury and apoptosis by upregulating the expression of brain-derived neurotrophic factor, nerve growth factor, and antiapoptotic B-cell lymphoma-extra large, while reducing proapoptotic cleaved caspase-3 protein. By introducing the Wnt/β-catenin signaling inhibitor XAV-939 and 5-bromo-2'-deoxyuridine staining, it was proved that XQ-1H promoted the proliferation of PC12 cells in a Wnt-signal-dependent manner via inhibiting the activation of glycogen synthase kinase-3β after phosphatidylinositol 3-kinase/protein kinase B signal activation, thereby activating Wnt1, β-catenin, and the expression of downstream neurogenic differentiation 1 and cyclin D1, which was comparable to Wnt/β-catenin signaling agonist 4,6-disubstituted pyrrolopyrimidine. We conclude that XQ-1H, after OGD/R damage to PC12 cells, may limit cell apoptosis in a Wnt/β-catenin signal-dependent manner, promoting cell proliferation and survival.
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Affiliation(s)
- Dan Xu
- Department of Physiology, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Fengyang Li
- Department of Physiology, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Kai Hou
- Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing, China
| | - Xue Gou
- Department of Physiology, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Weirong Fang
- Department of Physiology, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Yunman Li
- Department of Physiology, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
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Rossetti L, Iester M, Tranchina L, Ottobelli L, Coco G, Calcatelli E, Ancona C, Cirafici P, Manni G. Can Treatment With Citicoline Eyedrops Reduce Progression in Glaucoma? The Results of a Randomized Placebo-controlled Clinical Trial. J Glaucoma 2020; 29:513-520. [PMID: 32541370 PMCID: PMC7337116 DOI: 10.1097/ijg.0000000000001565] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/17/2020] [Indexed: 12/14/2022]
Abstract
PRECIS Citicoline eyedrops in patients with progressing glaucoma. PURPOSE This study aimed to test whether the additional therapy with citicoline eyedrops to intraocular pressure (IOP)-lowering treatment could slow glaucoma progression in patients with worsening of damage and IOP 18 mm Hg or less. DESIGN This was a randomized, double-masked, placebo-controlled, multicenter 3-year study. OUTCOMES The outcomes studied were difference in the visual field (mean deviation, MD, of 24-2; MD of 10-2) rates of progression and difference in retinal nerve fiber layer (RNFL) thickness change between the 2 study groups at 3 years. METHODS Patients with mild to moderate open-angle glaucoma (OAG) showing damage progression of at least -0.5 dB/y in the 2 years before enrollment despite IOP ≤18 mm Hg were randomized to receive citicoline eyedrops or placebo 3 times daily for 3 years. Patients were followed every 3 months and underwent a visual field examination with 24-2 and 10-2 strategies and RNFL assessment. Analysis of variance and linear models were used to test the differences between groups. RESULTS Eighty patients were randomized in the trial. The mean 3-year rates of progression were -1.03 (2.14) dB in the citicoline group and -1.92 (2.23) dB in the placebo group (P=0.07) for 24-2 MD and -0.41 (3.45) dB in the citicoline group and -2.22 (3.63) dB in the placebo group (P=0.02) for 10-2 MD. On average, patients receiving citicoline eyedrops lost 1.86 μm of RNFL in 3 years, versus 2.99 μm in the placebo group (P=0.02). CONCLUSIONS Additional treatment with citicoline eyedrops to IOP-lowering treatment might reduce disease progression in patients with progressing glaucoma despite IOP ≤18 mm Hg.
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Affiliation(s)
- Luca Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo, University of Milan, Milan
| | - Michele Iester
- Eye Clinic, DiNOGMI, University of Genoa
- IRCCS Policlinico San Martino Hospital, Genova
| | - Laura Tranchina
- Eye Clinic, ASST Santi Paolo e Carlo, University of Milan, Milan
| | - Laura Ottobelli
- Eye Clinic, ASST Santi Paolo e Carlo, University of Milan, Milan
| | - Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata
| | - Elisabetta Calcatelli
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata
| | - Chiara Ancona
- Eye Clinic, DiNOGMI, University of Genoa
- IRCCS Policlinico San Martino Hospital, Genova
| | - Paola Cirafici
- Eye Clinic, DiNOGMI, University of Genoa
- IRCCS Policlinico San Martino Hospital, Genova
| | - Gianluca Manni
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata
- Bietti Foundation, IRCCS, Rome, Italy
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