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Lénárt N, Cserép C, Császár E, Pósfai B, Dénes Á. Microglia-neuron-vascular interactions in ischemia. Glia 2024; 72:833-856. [PMID: 37964690 DOI: 10.1002/glia.24487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
Cerebral ischemia is a devastating condition that results in impaired blood flow in the brain leading to acute brain injury. As the most common form of stroke, occlusion of cerebral arteries leads to a characteristic sequence of pathophysiological changes in the brain tissue. The mechanisms involved, and comorbidities that determine outcome after an ischemic event appear to be highly heterogeneous. On their own, the processes leading to neuronal injury in the absence of sufficient blood supply to meet the metabolic demand of the cells are complex and manifest at different temporal and spatial scales. While the contribution of non-neuronal cells to stroke pathophysiology is increasingly recognized, recent data show that microglia, the main immune cells of the central nervous system parenchyma, play previously unrecognized roles in basic physiological processes beyond their inflammatory functions, which markedly change during ischemic conditions. In this review, we aim to discuss some of the known microglia-neuron-vascular interactions assumed to contribute to the acute and delayed pathologies after cerebral ischemia. Because the mechanisms of neuronal injury have been extensively discussed in several excellent previous reviews, here we focus on some recently explored pathways that may directly or indirectly shape neuronal injury through microglia-related actions. These discoveries suggest that modulating gliovascular processes in different forms of stroke and other neurological disorders might have presently unexplored therapeutic potential in combination with neuroprotective and flow restoration strategies.
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Affiliation(s)
- Nikolett Lénárt
- Momentum Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Csaba Cserép
- Momentum Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Eszter Császár
- Momentum Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Balázs Pósfai
- Momentum Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Ádám Dénes
- Momentum Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
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2
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Jiang Y, Dang Y, Wu Q, Yuan B, Gao L, You C. Using a k-means clustering to identify novel phenotypes of acute ischemic stroke and development of its Clinlabomics models. Front Neurol 2024; 15:1366307. [PMID: 38601342 PMCID: PMC11004235 DOI: 10.3389/fneur.2024.1366307] [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: 01/06/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Objective Acute ischemic stroke (AIS) is a heterogeneous condition. To stratify the heterogeneity, identify novel phenotypes, and develop Clinlabomics models of phenotypes that can conduct more personalized treatments for AIS. Methods In a retrospective analysis, consecutive AIS and non-AIS inpatients were enrolled. An unsupervised k-means clustering algorithm was used to classify AIS patients into distinct novel phenotypes. Besides, the intergroup comparisons across the phenotypes were performed in clinical and laboratory data. Next, the least absolute shrinkage and selection operator (LASSO) algorithm was used to select essential variables. In addition, Clinlabomics predictive models of phenotypes were established by a support vector machines (SVM) classifier. We used the area under curve (AUC), accuracy, sensitivity, and specificity to evaluate the performance of the models. Results Of the three derived phenotypes in 909 AIS patients [median age 64 (IQR: 17) years, 69% male], in phenotype 1 (N = 401), patients were relatively young and obese and had significantly elevated levels of lipids. Phenotype 2 (N = 463) was associated with abnormal ion levels. Phenotype 3 (N = 45) was characterized by the highest level of inflammation, accompanied by mild multiple-organ dysfunction. The external validation cohort prospectively collected 507 AIS patients [median age 60 (IQR: 18) years, 70% male]. Phenotype characteristics were similar in the validation cohort. After LASSO analysis, Clinlabomics models of phenotype 1 and 2 were constructed by the SVM algorithm, yielding high AUC (0.977, 95% CI: 0.961-0.993 and 0.984, 95% CI: 0.971-0.997), accuracy (0.936, 95% CI: 0.922-0.956 and 0.952, 95% CI: 0.938-0.972), sensitivity (0.984, 95% CI: 0.968-0.998 and 0.958, 95% CI: 0.939-0.984), and specificity (0.892, 95% CI: 0.874-0.926 and 0.945, 95% CI: 0.923-0.969). Conclusion In this study, three novel phenotypes that reflected the abnormal variables of AIS patients were identified, and the Clinlabomics models of phenotypes were established, which are conducive to individualized treatments.
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Affiliation(s)
- Yao Jiang
- Laboratory Medicine Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Yingqiang Dang
- Laboratory Medicine Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Qian Wu
- Laboratory Medicine Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Boyao Yuan
- Department of Neurology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Lina Gao
- Laboratory Medicine Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Chongge You
- Laboratory Medicine Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, China
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3
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Liu T, Wang W, Li X, Chen Y, Mu F, Wen A, Liu M, Ding Y. Advances of phytotherapy in ischemic stroke targeting PI3K/Akt signaling. Phytother Res 2023; 37:5509-5528. [PMID: 37641491 DOI: 10.1002/ptr.7994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
The pathogenesis of ischemic stroke is complex, and PI3K/Akt signaling is considered to play a crucial role in it. The PI3K/Akt pathway regulates inflammation, oxidative stress, apoptosis, autophagy, and vascular endothelial homeostasis after cerebral ischemia; therefore, drug research targeting the PI3K/Akt pathway has become the focus of scientists. In this review, we analyzed the research reports of antiischemic stroke drugs targeting the PI3K/Akt pathway in the past two decades. Because of the rich sources of natural products, increasing studies have explored the value of natural compounds, including Flavonoids, Quinones, Alkaloids, Phenylpropanoids, Phenols, Saponins, and Terpenoids, in alleviating neurological impairment and achieved satisfactory results. Herbal extracts and medicinal formulas have been applied in the treatment of ischemic stroke for thousands of years in East Asian countries. These precious clinical experiences provide a new avenue for research of antiischemic stroke drugs. Finally, we summarize and discuss the characteristics and shortcomings of the current research and put forward prospects for further in-depth exploration.
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Affiliation(s)
- Tianlong Liu
- Department of Pharmacy, The 940th Hospital Joint Logistics Support Forces of PLA, Lanzhou, China
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wenjun Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaolin Li
- Department of Pharmacy, The 940th Hospital Joint Logistics Support Forces of PLA, Lanzhou, China
| | - Yidan Chen
- Department of Pharmacy, The 940th Hospital Joint Logistics Support Forces of PLA, Lanzhou, China
| | - Fei Mu
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Aidong Wen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Minna Liu
- Department of Nephrology, The 940th Hospital Joint Logistics Support Forces of PLA, Lanzhou, China
| | - Yi Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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4
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Xu X, Guo W, Zhao L, Sun Y, Xu D, Yang J, Liu Y, Xie S, Wang Y, Xu Y. Exploring the in vitro anti-inflammatory activity of gross saponins of Tribulus terrestris L. fruit by using liquid chromatography-mass spectrometry-based cell metabolomics approach. J Sep Sci 2023; 46:e2300531. [PMID: 37933967 DOI: 10.1002/jssc.202300531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
Our previous studies confirmed the efficacy of gross saponins of Tribulus terrestris L. fruit in treating cerebral ischemia. This study aimed to investigate the related mechanisms in vitro. The lipopolysaccharide-induced BV2 cells model was constructed and treated with gross saponins at different concentrations to explore its anti-inflammatory activity. The cell metabolite changes were tracked by liquid chromatography-mass spectrometry (LC-MS)-based metabolomics, and the metabolic biomarkers and related metabolic pathways were analyzed. Molecular biochemistry analysis was further used to verify the relevant inflammatory pathways. The results showed that the saponins reduced nitric oxide release and the secretion of tumor necrosis factor-alpha, interleukin-1β, and interleukin-6 from lipopolysaccharide-induced BV2 cells. Metabolic perturbations occurred in lipopolysaccharide-treated BV2 cells, which could be reversed by drug treatment via mainly regulating glycerophospholipid metabolism, tryptophan metabolism, purine metabolism pathways, etc. The western blot analysis demonstrated that saponin could suppress the activation of the inflammatory-related signaling pathway. The present study explored the in vitro anti-inflammatory mechanism of gross saponins of Tribulus terrestris L. fruit using an LC-MS-based cell metabolomics approach, which confirms the great potential of LC-MS for drug efficacy evaluation and can be applied in other herbal medicine-related analyses.
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Affiliation(s)
- Xiaohang Xu
- School of Pharmaceutical Sciences, Changchun University of Chinese Medicine, Changchun, China
- Key Laboratory of Medicinal Materials, Jilin Academy of Chinese Medicine Sciences, Changchun, China
| | - Wenjun Guo
- School of Pharmaceutical Sciences, Changchun University of Chinese Medicine, Changchun, China
| | - Liang Zhao
- Key Laboratory of Medicinal Materials, Jilin Academy of Chinese Medicine Sciences, Changchun, China
| | - Yuanhe Sun
- School of Pharmaceutical Sciences, Changchun University of Chinese Medicine, Changchun, China
| | - Dandan Xu
- Key Laboratory of Medicinal Materials, Jilin Academy of Chinese Medicine Sciences, Changchun, China
| | - Jingxuan Yang
- School of Pharmaceutical Sciences, Changchun University of Chinese Medicine, Changchun, China
| | - Yue Liu
- Key Laboratory of Medicinal Materials, Jilin Academy of Chinese Medicine Sciences, Changchun, China
| | - Shengxu Xie
- Key Laboratory of Medicinal Materials, Jilin Academy of Chinese Medicine Sciences, Changchun, China
| | - Yang Wang
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Yajuan Xu
- Key Laboratory of Medicinal Materials, Jilin Academy of Chinese Medicine Sciences, Changchun, China
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Teder T, Haeggström JZ, Airavaara M, Lõhelaid H. Cross-talk between bioactive lipid mediators and the unfolded protein response in ischemic stroke. Prostaglandins Other Lipid Mediat 2023; 168:106760. [PMID: 37331425 DOI: 10.1016/j.prostaglandins.2023.106760] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
Ischemic cerebral stroke is a severe medical condition that affects about 15 million people every year and is the second leading cause of death and disability globally. Ischemic stroke results in neuronal cell death and neurological impairment. Current therapies may not adequately address the deleterious metabolic changes and may increase neurological damage. Oxygen and nutrient depletion along with the tissue damage result in endoplasmic reticulum (ER) stress, including the Unfolded Protein Response (UPR), and neuroinflammation in the affected area and cause cell death in the lesion core. The spatio-temporal production of lipid mediators, either pro-inflammatory or pro-resolving, decides the course and outcome of stroke. The modulation of the UPR as well as the resolution of inflammation promotes post-stroke cellular viability and neuroprotection. However, studies about the interplay between the UPR and bioactive lipid mediators remain elusive and this review gives insights about the crosstalk between lipid mediators and the UPR in ischemic stroke. Overall, the treatment of ischemic stroke is often inadequate due to lack of effective drugs, thus, this review will provide novel therapeutical strategies that could promote the functional recovery from ischemic stroke.
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Affiliation(s)
- Tarvi Teder
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Z Haeggström
- Division of Physiological Chemistry II, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Mikko Airavaara
- Neuroscience Center, HiLIFE, University of Helsinki, Finland; Drug Research Program, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Helike Lõhelaid
- Neuroscience Center, HiLIFE, University of Helsinki, Finland; Drug Research Program, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.
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Haiyong Z, Wencai L, Yunxiang Z, Shaohuai X, Kailiang Z, Ke X, Wenjie Q, Gang Z, Jiansheng C, Yifan D, Zhongzong Q, Huanpeng L, Honghai L. Construction of a Nomogram Prediction Model for Prognosis in Patients with Large Artery Occlusion-Acute Ischemic Stroke. World Neurosurg 2023; 172:e39-e51. [PMID: 36455850 DOI: 10.1016/j.wneu.2022.11.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with large artery occlusion-acute ischemic stroke (LAO-AIS) can experience adverse outcomes, such as brain herniation due to complications. This study aimed to construct a nomogram prediction model for prognosis in patients with LAO-AIS in order to maximize the benefits for clinical patients. METHODS Retrospective analysis of 243 patients with LAO-AIS from January 2019 to January 2022 with medical history data and blood examination at admission. Univariate and multivariate analyses were conducted through binary logistic regression equation analysis, and a nomogram prediction model was constructed. RESULTS Results of this study showed that hyperlipidemia (odds ratio [OR] = 2.849, 95% confidence interval [CI] = 1.100-7.375, P = 0.031), right cerebral infarction (OR = 2.144, 95% CI = 1.106-4.156, P = 0.024), D-Dimer>500 ng/mL (OR = 2.891, 95% CI = 1.398-5.980, P = 0.004), and neutrophil-lymphocyte ratio >7.8 (OR = 2.149, 95% CI = 1.093-4.225, P = 0.027) were independent risk factors for poor early prognosis in patients with LAO-AIS. In addition, hypertension (OR = 1.947, 95% CI = 1.114-3.405, P = 0.019), hyperlipidemia (OR = 2.594, 95% CI = 1.281-5.252, P = 0.008), smoking (OR = 2.414, 95% CI = 1.368-4.261, P = 0.002), D-dimer>500 ng/mL (OR = 3.170, 95% CI = 1.533-6.553, P = 0.002), and neutrophil-lymphocyte ratio >7.8 (OR = 2.144, 95% CI = 1.231-3.735, P = 0.007) were independent risk factors for poor long-term prognosis. The early prognosis nomogram receiver operating characteristic curve area under the curve value was 0.688 for the training set and 0.805 for the validation set, which was highly differentiated. The mean error was 0.025 for the training set calibration curve and 0.016 for the validation set calibration curve. Both the training and validation set decision curve analyses indicated that the clinical benefit of the nomogram was significant. The long-term prognosis nomogram receiver operating characteristic curve area under the curve values was 0.697 for the training set and 0.735 for the validation set, showing high differentiation. The mean error was 0.041 for the training set calibration curve and 0.021 for the validation set calibration curve. Both of the training and validation set decision curve analyses demonstrated a substantial clinical benefit of the nomogram. CONCLUSIONS The nomogram prediction model based on admission history data and blood examination are easy-to-use tools that provide an accurate individualized prediction for patients with LAO-AIS and can assist in early clinical decisions and in obtaining an early prognosis.
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Affiliation(s)
- Zeng Haiyong
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Li Wencai
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Zhou Yunxiang
- Department of Neurosurgery, Affliated Hospital of Guilin Medical University, Guilin, China
| | - Xia Shaohuai
- Department of Neurosurgery, Affliated Hospital of Guilin Medical University, Guilin, China
| | - Zeng Kailiang
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Xu Ke
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Qiu Wenjie
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Zhu Gang
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Chen Jiansheng
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Deng Yifan
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Qin Zhongzong
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Li Huanpeng
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Luo Honghai
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China.
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Sheng B, Li YZ, Wu AP, Wang DD, Yang PP. Salidroside attenuates oxygen and glucose deprivation-induced neuronal injury by inhibiting ferroptosis. Asian Pac J Trop Biomed 2023. [DOI: 10.4103/2221-1691.369611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Yang K, Bao T, Zeng J, Wang S, Yuan X, Xiang W, Xu H, Zeng L, Ge J. Research progress on pyroptosis-mediated immune-inflammatory response in ischemic stroke and the role of natural plant components as regulator of pyroptosis: A review. Biomed Pharmacother 2023; 157:113999. [PMID: 36455455 DOI: 10.1016/j.biopha.2022.113999] [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] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
Ischemic stroke (IS) is one of the leading causes of death and disability. Its pathogenesis is not completely clear, and inflammatory cascade is one of its main pathological processes. The current clinical practice of IS is to restore the blood supply to the ischemic area after IS as soon as possible through thrombolytic therapy to protect the vitality and function of neurons. However, blood reperfusion further accelerates ischemic damage and cause ischemia-reperfusion injury. The pathological process of cerebral ischemia-reperfusion injury involves multiple mechanisms, and the exact mechanism has not been fully elucidated. Pyroptosis, a newly discovered form of inflammatory programmed cell death, plays an important role in the initiation and progression of inflammation. It is a pro-inflammatory programmed death mediated by caspase Caspase-1/4/5/11, which can lead to cell swelling and rupture, release inflammatory factors IL-1β and IL-18, and induce an inflammatory cascade. Recent studies have shown that pyroptosis and its mediated inflammatory response are important factors in aggravating ischemic brain injury, and inhibition of pyroptosis may alleviate the ischemic brain injury. Furthermore, studies have found that natural plant components may have a regulatory effect on pyroptosis. Therefore, this review not only summarizes the molecular mechanism of pyroptosis and its role in ischemic stroke, but also the role of natural plant components as regulator of pyroptosis, in order to provide reference information on pyroptosis for the treatment of IS in the future.
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Affiliation(s)
- Kailin 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, Hunan Province, China.
| | - Tingting Bao
- Department of Endocrinology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinsong Zeng
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Shanshan Wang
- 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, Hunan Province, China
| | - Xiao Yuan
- 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, Hunan Province, China
| | - Wang Xiang
- Department of Rheumatology, The First People's Hospital Changde City, Changde City, Hunan Province, China
| | - Hao Xu
- 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, Hunan Province, China
| | - Liuting Zeng
- 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, Hunan Province, China.
| | - Jinwen 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, Hunan Province, China; Hunan Academy of Chinese Medicine, Changsha, Hunan Province, China.
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Analysis of SOCS3 gene genotype in patients with acute cerebral infarction and its relationship with disease progression. Clin Neurol Neurosurg 2022; 224:107518. [PMID: 36434897 DOI: 10.1016/j.clineuro.2022.107518] [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: 09/19/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This reseaech aimed to analyze the polymorphism of SOCS3 gene in patients with acute cerebral infarction (ACI), and to explore its relationship with disease progression. METHODS A total of 310 patients with ACI were categorized into mild stroke group and moderate to severe stroke group according to the National Institute of Stroke Scale (NIHSS) score at admission. Based on NIHSS scores at 7 days after admission, patients were further divided into advanced group and non-advanced group. According to the results of SOCS3 gene detection, three genotypes of rs8064821 were detected: CC, CA and AA. The distribution difference of the genotypes and their predictive possibility were reckoned. RESULTS The distribution of SOCS3 genotype at rs8064821 in patients with ACI was CC (161 cases), CA (127 cases), and AA (22 cases), with frequencies of 51.93 %, 40.97 %, and 7.10 %, respectively. Compared with mild group, the proportion of CC genotype was lower, while the proportion of CA and AA genotypes was higher in moderate-severe stroke group (P < 0.01). Compared with non-advanced group, patients who advanced to neurological deficit had a lower proportion of CC genotype, and a higher proportion of CA and AA genotype (P < 0.01). CONCLUSION CA and AA genotypes were the main genotypes of SOCS3 in patients with ACI in northern Anhui of China. The disease was more severe in patients with CA and AA, who are more likely to develop neurological deficits.
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10
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Zhang R, Jin F, Zheng L, Liao T, Guan G, Wang J, Zhao S, Fei S, Chu Z, Xu Y. Neutrophil to High-Density Lipoprotein Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke. J Inflamm Res 2022; 15:6073-6085. [PMID: 36386588 PMCID: PMC9642365 DOI: 10.2147/jir.s381036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/18/2022] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Hemorrhagic transformation (HT) is one of the most common and severe complications in patients with acute ischemic stroke (AIS). It indicates a poor prognosis in AIS patients. However, the association of neutrophil to high-density lipoprotein ratio (NHR) with HT remains unclear. PURPOSE This study examined whether the NHR has a predictive effect on HT in AIS patients and explored the predictive cutoff value of the NHR. METHODS This is a retrospective study and consecutively included AIS patients admitted to the Department of Neurology of the First Affiliated Hospital of Wannan Medical College between December 2019 and January 2022. All subjects had blood samples collected within 24 h of admission, and neutrophil counts and high-density lipoprotein counts were detected. HT was diagnosed with hemorrhage on subsequent magnetic resonance imaging (MRI) or computed tomography (CT) of the brain. Univariate logistic regression analysis was performed to identify confounding factors, and multivariate logistic regression analysis determined the correlation between NHR and HT. Receiver operating characteristic (ROC) curves were used to evaluate the clinical predictive value of NHR. RESULTS A total of 725 patients were finally included in this study, of which 87 (12%) developed HT. The median NHR value in the HT group was 4.31, which was significantly higher than that in the non-HT group, and the difference was statistically significant [4.31 (3.54-6.24) vs 3.63 (2.68-4.64), p < 0.001]. The binary logistic regression analysis showed that NHR was independently associated with HT in AIS patients (OR: 1.180, 95% CI: 1.036-1.344, p = 0.013). The area under ROC curve (AUC) of NHR for predicting HT in AIS patients was 0.633 (95% CI: 0.567-0.699, p < 0.001), and its optimal cutoff were 3.52. CONCLUSION The NHR was a reliable and simple independent predictor of HT in AIS patients.
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Affiliation(s)
- Ruirui Zhang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Fanfu Jin
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Lanlan Zheng
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Tingwei Liao
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Guangling Guan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Jianfei Wang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Shoucai Zhao
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Shizao Fei
- Wuhu Hospital, East China Normal University, Wuhu, People’s Republic of China
| | - Zhaohu Chu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Yang Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institutes, Wannan Medical College, Wuhu, Anhui Province, China; Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
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11
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Ma Y, Chen Z, He Q, Guo ZN, Yang Y, Liu F, Li F, Luo Q, Chang J. Spatiotemporal lipidomics reveals key features of brain lipid dynamic changes after cerebral ischemia and reperfusion therapy. Pharmacol Res 2022; 185:106482. [DOI: 10.1016/j.phrs.2022.106482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/03/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
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12
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Papait A, Silini AR, Gazouli M, Malvicini R, Muraca M, O’Driscoll L, Pacienza N, Toh WS, Yannarelli G, Ponsaerts P, Parolini O, Eissner G, Pozzobon M, Lim SK, Giebel B. Perinatal derivatives: How to best validate their immunomodulatory functions. Front Bioeng Biotechnol 2022; 10:981061. [PMID: 36185431 PMCID: PMC9518643 DOI: 10.3389/fbioe.2022.981061] [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: 06/29/2022] [Accepted: 08/12/2022] [Indexed: 11/27/2022] Open
Abstract
Perinatal tissues, mainly the placenta and umbilical cord, contain a variety of different somatic stem and progenitor cell types, including those of the hematopoietic system, multipotent mesenchymal stromal cells (MSCs), epithelial cells and amnion epithelial cells. Several of these perinatal derivatives (PnDs), as well as their secreted products, have been reported to exert immunomodulatory therapeutic and regenerative functions in a variety of pre-clinical disease models. Following experience with MSCs and their extracellular vesicle (EV) products, successful clinical translation of PnDs will require robust functional assays that are predictive for the relevant therapeutic potency. Using the examples of T cell and monocyte/macrophage assays, we here discuss several assay relevant parameters for assessing the immunomodulatory activities of PnDs. Furthermore, we highlight the need to correlate the in vitro assay results with preclinical or clinical outcomes in order to ensure valid predictions about the in vivo potency of therapeutic PnD cells/products in individual disease settings.
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Affiliation(s)
- Andrea Papait
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Antonietta Rosa Silini
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Maria Gazouli
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ricardo Malvicini
- Department of Women and Children Health, University of Padova, Padova, Italy
- Laboratorio de Regulación Génica y Células Madre, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Maurizio Muraca
- Department of Women and Children Health, University of Padova, Padova, Italy
| | - Lorraine O’Driscoll
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Trinity St. James’s Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Natalia Pacienza
- Laboratorio de Regulación Génica y Células Madre, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Wei Seong Toh
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gustavo Yannarelli
- Laboratorio de Regulación Génica y Células Madre, Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Peter Ponsaerts
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Antwerp, Belgium
| | - Ornella Parolini
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Günther Eissner
- Systems Biology Ireland, School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Michela Pozzobon
- Department of Women and Children Health, University of Padova, Padova, Italy
| | - Sai Kiang Lim
- Institute of Medical Biology and Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Bernd Giebel
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Zhang M, Chen H, Liu G, Wang X, Wang Z, Feng T, Zhang Y. Lower serum triglyceride levels linked to more severe motor performance in Parkinson’s disease. Neurol Sci 2022; 43:5343-5353. [PMID: 35608738 PMCID: PMC9385747 DOI: 10.1007/s10072-022-06113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022]
Abstract
Introduction Emerging evidence has suggested that lipid metabolism is correlated with Parkinson’s disease (PD) onset and progression. However, the effect of lipid metabolism on motor performance in PD patients is still unknown. This study estimated the association between lipid profiles and the severity of motor performance in PD. Methods This cross-sectional study enrolled 279 idiopathic PD patients from the Department of Neurology of Beijing Tiantan Hospital from May 2016 to August 2018. Serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (Apo-A1), and apolipoprotein B (Apo-B) levels were detected in fast serum samples. Motor performance was assessed by Movement Disorder Society-Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) total scores and subscores in these patients. The associations of lipid profiles with motor performance were analyzed using multivariable linear regression models. Results Compared to males, females with PD exhibited significantly higher serum TC, LDL-C, HDL-C, Apo-A1, and Apo-B levels. When accounting for covariates, lower serum TG levels were significantly associated with higher MDS-UPDRS III total scores and gait/postural instability subscores. Additionally, the univariate linear regression model showed that in males with PD, serum HDL-C or Apo-A1 levels were significantly associated with tremor subscores. Conclusion Lower serum TG levels were associated with more severe motor performance in patients with PD and TG may be a potential predictive biomarker for motor performance in PD patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06113-9.
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Affiliation(s)
- Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Huimin Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Genliang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
| | - Yumei Zhang
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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14
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Lai M, Zhang X, Zhou D, Zhang X, Zhu M, Liu Q, Zhang Y, Wang D. Integrating serum proteomics and metabolomics to compare the common and distinct features between acute aggressive ischemic stroke (APIS) and acute non-aggressive ischemic stroke (ANPIS). J Proteomics 2022; 261:104581. [PMID: 35421619 DOI: 10.1016/j.jprot.2022.104581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/02/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Understanding common and distinct pathophysiological features between acute progressive ischemic stroke (APIS) and acute non-progressive ischemic stroke (ANPIS) is a prerequisite to making clear the mechanism to determine the prognosis of acute ischemic stroke (AIS). Here, we recruited three independent sets of subjects, all of which included the APIS, ANPIS, and control groups. They were used for serum proteomic and metabolomic analyses, and validation of the critical pathophysiological processes and potential biomarkers of APIS, respectively. Results showed that there were both common and distinct metabolome and proteome between APIS and ANPIS. APIS and ANPIS shared basic processes of AIS in inflammation and oxidative stress response. Coagulation and lipid metabolism disorder, activation of the complement system, and inflammation may enhance with each other in the symptom worsening of APIS. The contents of serum amyloid A1 (SAA1) and S100 calcium-binding protein A9 (S100-A9) in the validation set confirmed the key pathophysiological processes indicated by omics data; they also jointly conferred a moderate value to distinguish APIS from ANPIS. Collectively, disturbance in coagulation and lipid metabolism, complement activation, and inflammation may be synergistically involved in symptom deterioration in APIS. SAA1 and S100-A9 serve as a potential biomarker panel to distinguish APIS from ANPIS. THE SIGNIFICANCE: In this study, we integrated serum proteomics and metabolomics to explore the similarities and differences in pathophysiological processes between APIS and ANPIS. The global metabolic networks have been constructed, and the crucial common pathophysiological processes and the key distinct pathophysiological features between APIS and ANPIS were investigated based on the differentially expressed proteins and metabolites (DEPs/DEMs). Furthermore, pivotal serum proteins (SAA1 and S100A9) were detected in a dependent set to validate the key pathophysiological characteristics, as well as to assess the possibility of them being used as a biomarker panel. Taken together, the multi-omics integration strategy used in this clinical study shows potential to comprehensively interpret and compare the pathophysiological processes of AIS in various conditions, as well as to screen a reliable new biomarker panel.
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Affiliation(s)
- Minchao Lai
- Department of Neurology, First Affiliated Hospital of Shantou University Medical College, China
| | - Xiaojun Zhang
- Institute of Marine Sciences and Guangdong Provincial Key Laboratory of Marine Biotechnology, Shantou University, Shantou, China
| | - Danya Zhou
- Department of Forensic Medicine, Shantou, China; School of Basic Medicine, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | | | | | - Qingxian Liu
- Department of Nursing, Shantou University Medical College (SUMC), China
| | - Ye Zhang
- Department of Forensic Medicine, Shantou, China
| | - Dian Wang
- Department of Forensic Medicine, Shantou, China.
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15
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Sharma D, Spring KJ, Bhaskar SMM. Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis. J Cent Nerv Syst Dis 2022; 14:11795735221092518. [PMID: 35492740 PMCID: PMC9052237 DOI: 10.1177/11795735221092518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Background Inflammation may mediate response to acute reperfusion therapy (RT) in acute
cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory
biomarker, may play an important role in acute ischaemic stroke (AIS)
prognostication. Objective This meta-analysis sought to examine the effect of NLR on functional
outcomes, mortality and adverse outcomes in AIS patients receiving RT. Methods Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane
databases. Data were extracted using a standardised data sheet and
meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR
with clinical/safety outcomes after RT was conducted. Results Thirty-five studies (n = 10 308) were identified for the systematic review
with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was
associated with good functional outcomes (GFOs), defined as 3-month modified
Rankin scale (mRS) 0–2 (SMD = −.46; 95% CI = −.62 to −.29; P < .0001),
mRS 0–1 (SMD = −.44; 95% CI = −.66 to −.22; P < .0001) and early
neurological improvement (ENI) (SMD = −.55; 95 %CI = −.84 to −.25; P <
.0001). Lower delayed admission NLR was also associated with GFOs (SMD =
−.80; 95%CI = −.91 to −.68; P < .0001). Higher admission NLR was
significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P =
.009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P =
.007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and
stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P
< .0001). Higher delayed NLR was significantly associated with sICH (SMD
= 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to
1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P <
.0001). There were variations in outcomes across RT groups. Conclusion Higher admission or delayed NLR is significantly associated with worse
morbidity, mortality and safety outcomes in AIS patients receiving RT.
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Affiliation(s)
- Divyansh Sharma
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kevin J. Spring
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Comprehensive Stroke Center, Sydney, NSW, Australia
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16
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Ravindranath MH, El Hilali F, Filippone EJ. The Impact of Inflammation on the Immune Responses to Transplantation: Tolerance or Rejection? Front Immunol 2021; 12:667834. [PMID: 34880853 PMCID: PMC8647190 DOI: 10.3389/fimmu.2021.667834] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022] Open
Abstract
Transplantation (Tx) remains the optimal therapy for end-stage disease (ESD) of various solid organs. Although alloimmune events remain the leading cause of long-term allograft loss, many patients develop innate and adaptive immune responses leading to graft tolerance. The focus of this review is to provide an overview of selected aspects of the effects of inflammation on this delicate balance following solid organ transplantation. Initially, we discuss the inflammatory mediators detectable in an ESD patient. Then, the specific inflammatory mediators found post-Tx are elucidated. We examine the reciprocal relationship between donor-derived passenger leukocytes (PLs) and those of the recipient, with additional emphasis on extracellular vesicles, specifically exosomes, and we examine their role in determining the balance between tolerance and rejection. The concept of recipient antigen-presenting cell "cross-dressing" by donor exosomes is detailed. Immunological consequences of the changes undergone by cell surface antigens, including HLA molecules in donor and host immune cells activated by proinflammatory cytokines, are examined. Inflammation-mediated donor endothelial cell (EC) activation is discussed along with the effect of donor-recipient EC chimerism. Finally, as an example of a specific inflammatory mediator, a detailed analysis is provided on the dynamic role of Interleukin-6 (IL-6) and its receptor post-Tx, especially given the potential for therapeutic interdiction of this axis with monoclonal antibodies. We aim to provide a holistic as well as a reductionist perspective of the inflammation-impacted immune events that precede and follow Tx. The objective is to differentiate tolerogenic inflammation from that enhancing rejection, for potential therapeutic modifications. (Words 247).
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Affiliation(s)
- Mepur H. Ravindranath
- Department of Hematology and Oncology, Children’s Hospital, Los Angeles, CA, United States
- Terasaki Foundation Laboratory, Santa Monica, CA, United States
| | | | - Edward J. Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
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17
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Sharma D, Spring KJ, Bhaskar SMM. Neutrophil-lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis. Acta Neurol Scand 2021; 144:486-499. [PMID: 34190348 DOI: 10.1111/ane.13493] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022]
Abstract
There is an ongoing need for accurate prognostic biomarkers in the milieu of acute ischemic stroke (AIS) receiving reperfusion therapy. Neutrophil-lymphocyte ratio (NLR) has been implicated in emergency medicine and acute stroke setting as an important biomarker in the prognosis of patients. However, there are ongoing questions around its accuracy and translation into clinical practice given suboptimal sensitivity and specificity results, as well as varying thresholds and lack of clarity around which NLR time points are most clinically indicative. This article provides a comprehensive overview of the role of NLR in AIS patients receiving reperfusion therapy and perspectives on areas of future research. NLR may be an important biomarker in risk stratifying patients in AIS to identify and select those who are more likely to benefit from reperfusion therapy. Appropriate clinical decision-making tools and models are required to harness the predictive value of NLR, which could be useful in identifying and monitoring high-risk patients to guide early treatment and achieve improved outcomes. Our understanding of the role of NLR in the immunopathogenesis of AIS is also suboptimal, which hinders the ability to translate this into clinical practice.
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Affiliation(s)
- Divyansh Sharma
- Neurovascular Imaging Laboratory Clinical Sciences Stream Ingham Institute for Applied Medical Research Sydney NSW Australia
- South Western Sydney Clinical School University of New South Wales (UNSW) Sydney NSW Australia
| | - Kevin J. Spring
- South Western Sydney Clinical School University of New South Wales (UNSW) Sydney NSW Australia
- NSW Health Pathology NSW Brain Clot Bank Sydney NSW Australia
- Medical Oncology Group Liverpool Clinical School Western Sydney University & Ingham Institute of Applied Medical Research Sydney NSW Australia
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory Clinical Sciences Stream Ingham Institute for Applied Medical Research Sydney NSW Australia
- NSW Health Pathology NSW Brain Clot Bank Sydney NSW Australia
- Department of Neurology & Neurophysiology Liverpool Hospital and South Western Sydney Local Health District (SWSLHD) Sydney NSW Australia
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18
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Neuroprotective effect of magnesium supplementation on cerebral ischemic diseases. Life Sci 2021; 272:119257. [PMID: 33631176 DOI: 10.1016/j.lfs.2021.119257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Ischemic encephalopathy is associated with a high mortality and rate of disability. The most common type of ischemic encephalopathy, ischemic stroke, is the second leading cause of death in the world. At present, the main treatment for ischemic stroke is to reopen blocked blood vessels. However, despite revascularization, many patients are not able to achieve good functional results. At the same time, the strict time window (<4.5 h) of thrombolytic therapy limits clinical application. Therefore, it is important to explore effective neuroprotective drugs for the treatment of ischemic stroke. Magnesium is a natural calcium antagonist, which exerts neuroprotective effects through various mechanisms. However, while most basic studies have shown that magnesium supplementation can help treat cerebral ischemia, intravenous magnesium supplementation in large clinical trials has failed to improve prognosis of ischemic patients. Therefore, we review the basic and clinical studies of magnesium supplementation for cerebral ischemia. According to the route of administration, treatment can be divided into intraperitoneal magnesium supplementation, intravenous magnesium supplementation, arterial magnesium supplementation and intracranial magnesium supplementation. We also summarized the potential influencing factors of magnesium ion intervention in cerebral ischemia injury. Finally, in combination with influencing factors derived from basic research, this article proposes three future research directions, including magnesium supplementation into the circulatory system combined with magnesium supplementation in the lateral ventricle, magnesium supplementation in the lateral ventricle combined with hypothermia therapy, and lateral ventricle magnesium supplementation combined with intracarotid magnesium supplementation combined with selective hypothermia.
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19
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Suzuki K, Shichita T. Introduction: Immuno-neural Connections Special Issue. Int Immunol 2020. [DOI: 10.1093/intimm/dxaa065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kazuhiro Suzuki
- WPI Immunology Frontier Research Center, Osaka, Japan
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
- Precursory Research for Innovative Medical Care (PRIME), Japan Agency for Medical Research and Development (AMED), Tokyo, Japan
| | - Takashi Shichita
- Precursory Research for Innovative Medical Care (PRIME), Japan Agency for Medical Research and Development (AMED), Tokyo, Japan
- Stroke Renaissance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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20
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Cheng HR, Song JY, Zhang YN, Chen YB, Lin GQ, Huang GQ, He JC, Wang Z. High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia. Front Neurol 2020; 11:575809. [PMID: 33123080 PMCID: PMC7573136 DOI: 10.3389/fneur.2020.575809] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: Stroke-associated pneumonia (SAP), a common complication in acute ischemic stroke (AIS) patients, is associated with poor prognosis after AIS. Inflammation plays an important role in the development of SAP. In this study, we aimed to explore the association between the monocyte-to-lymphocyte ratio (MLR) and SAP in AIS patients. Methods: We continuously enrolled 972 AIS patients. SAP was diagnosed by two trained neurologists and confirmed by radiography, meeting the modified Centers for Disease Control and Prevention criteria. MLR values were measured for all participants, and all patients were evenly classified into three tertiles according to the MLR levels. We used the values that Youden's index max points corresponded to represent the optimal cutoffs, which represented the balance in sensitivity and specificity. Results: 104 (10.7%) patients were diagnosed with SAP. SAP patients showed a significant increased (P < 0.001) MLR when compared with non-SAP. The optimal cutoff points of MLR were (T1) <0.2513, (T2) 0.2513–0.3843, and (T3) > 0.3843. The incidence of SAP was significantly higher in the third MLR tertile than the first and second MLR tertiles (21.7 vs. 4 vs. 6.5%, respectively, P < 0.001). After adjusting for confounding and risk factors, multivariate regression analysis showed that the third MLR tertile was an independent variable predicting the occurrence of SAP (odds ratio = 3.503, 95%CI = 1.066–11.515, P = 0.039). Conclusions: Our study showed that higher MLR was significantly associated with SAP in AIS patients. MLR is beneficial for clinicians to recognize patients with a high risk of SAP at an early stage and is an effective way to improve clinical care of SAP patients. Higher MLR could be a helpful and valid biomarker for predicting SAP in clinical practice.
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Affiliation(s)
- Hao-Ran Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia-Ying Song
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yi-Nuo Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun-Bin Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gang-Qiang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gui-Qian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jin-Cai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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