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Moñivas Gallego E, Zurita Castillo M. Mesenchymal stem cell therapy in ischemic stroke trials. A systematic review. Regen Ther 2024; 27:301-306. [PMID: 38633415 PMCID: PMC11021793 DOI: 10.1016/j.reth.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
Cerebrovascular accidents, also known as strokes, are the leading cause of permanent disability in society, presenting significant socioeconomic and healthcare costs. They can be caused by ischemic factors or hemorrhages, with ischemic strokes being the most common among the population. Therapies for patients suffering from this condition are limited and primarily focus on acute-phase treatment. In recent years, there has been an increase in cellular therapies, employing Stem Cells to mitigate or eliminate the consequences arising from this disease. Mesenchymal Stem Cells (MSCs) hold substantial therapeutic potential in Nervous System pathologies due to their low antigenicity and capacity to differentiate into various human tissues, such as adipogenic, chondrogenic, and osteogenic tissues. This study conducts a literature review using the "clinical trials" and "Pubmed" database, summarizing all ongoing clinical trials for ischemic strokes that utilize MSCs as treatment.
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Affiliation(s)
- Ester Moñivas Gallego
- Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro Majadahonda, Spain
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2
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Deng Y, Sun S. Runx1 promotes neuronal injury in ischemic stroke through mediating miR-203-3p/Pde4d axis. Brain Inj 2024; 38:1035-1045. [PMID: 38994671 DOI: 10.1080/02699052.2024.2373914] [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: 03/08/2024] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND It has been reported that Runx1 engaged in IS progression, but the detailed mechanism of Runx1 in IS is still unclear. METHODS Mice and HT22 cells were subjected to the process of middle cerebral artery occlusion and reperfusion (MCAO/R) and oxygen-glucose deprivation/reoxygenation (OGD/R), respectively. Infract volume was tested using TTC staining. The levels of inflammatory cytokines were investigated using ELISA assay. Cell viability was examined utilizing MTS. Apoptosis rate was evaluated using flow cytometry and TUNEL. The productions of SOD and MDA were monitored by means of commercial kits. The correlations among Runx1, miR-203-3p and Pde4d were ascertained using dual luciferase reporter gene, ChIP and RNA-RNA pull-down assays. RESULTS Runx1 and Pde4d were abnormally elevated, while miR-203-3p was notably declined in MCAO/R mice and OGD/R-induced HT22 cells. OGD/R treatment suppressed cell viability and facilitated cell apoptosis, inflammation and oxidative stress, which were compromised by Runx1 knockdown or miR-203-3p upregulation. Runx1 bound to miR-203-3p promoter, thus decreasing miR-203-3p expression. MiR-203-3p inhibited Pde4d expression via targeting Pde4d mRNA. Runx1 deficiency-induced protection effects on OGD/R-treated HT22 cells were offset by miR-203-3p downregulation. CONCLUSION Runx1 aggravated neuronal injury caused by IS through mediating miR-203-3p/Pde4d axis.
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Affiliation(s)
- Yongwen Deng
- Department of Neurosurgery, Hunan Provincial People's Hospital (The first affiliated hospital of Hunan normal university), Changsha, Hunan, P.R. China
| | - Shengli Sun
- Department of Neurosurgery, Hunan Provincial People's Hospital (The first affiliated hospital of Hunan normal university), Changsha, Hunan, P.R. China
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He X, Wang Z, Ge Q, Sun S, Li R, Wang B. Lactylation of nuclear receptor coactivator 4 promotes ferritinophagy and glycolysis of neuronal cells after cerebral ischemic injury. Neuroreport 2024; 35:895-903. [PMID: 39166386 DOI: 10.1097/wnr.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Ischemic stroke remains a major cause of disability and mortality. Nuclear receptor coactivator 4 (NCOA4)-mediated ferritinophagy is involved in cerebral ischemic injury. Additionally, lactylation regulates the progression of ischemia injury. This study aimed to investigate the impact of NCOA4 on ferritinophagy and glycolysis of hippocampal neuron cells and its lactylation modification. Middle cerebral artery occlusion (MCAO) mouse and oxygen-glucose deprivation (OGD)-treated HT22 cell models were generated. Ferritinophagy was evaluated via detecting ferrous iron (Fe 2+ ), glutathione, malondialdehyde, and protein levels. Glycolysis was assessed by examining the glucose consumption, lactate production, and extracellular acidification rate. The lactylation was evaluated using immunoprecipitation and immunoblotting. Brain injury in vivo was analyzed by measuring brain infarct and neurological function. The results showed that NCOA4 expression was increased in the blood of patients with acute ischemia stroke, the peri-infarct region of the brain in MCAO mice (increased percentage: 142.11%) and OGD-treated cells (increased percentage: 114.70%). Knockdown of NCOA4 inhibited ferritinophagy and glycolysis of HT22 cells induced by OGD. Moreover, OGD promoted the lactylation of NCOA4 at lysine (K)450 sites, which enhanced NCOA4 protein stability. Additionally, interfering with NCOA4 attenuated brain infarction and neurological dysfunction in MCAO mice. Lactylation of NCOA4 at K450 sites promotes ferritinophagy and glycolysis of hippocampal neuron cells, thereby accelerating cerebral ischemic injury. These findings suggest a novel pathogenesis of ischemic stroke.
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Affiliation(s)
- Xiaoyin He
- Department of Neurology, The Air Force Hospital of Southern Theater Command, PLA, Guangzhou, China
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Song T, Li J, Xia Y, Hou S, Zhang X, Wang Y. 1,25-D3 ameliorates ischemic brain injury by alleviating endoplasmic reticulum stress and ferroptosis: Involvement of vitamin D receptor and p53 signaling. Cell Signal 2024; 122:111331. [PMID: 39094671 DOI: 10.1016/j.cellsig.2024.111331] [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: 04/27/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
Endoplasmic reticulum stress (ERS) and ferroptosis are linked to cerebral ischemia reperfusion injury (CIRI). The neuroprotective properties of 1α, 25-dihydroxyvitamin D3 (VitD3 or 1,25-D3) have been well established; however, the mechanism by which VitD3 treats CIRI through ERS and ferroptosis has not been examined. Hence, we developed middle cerebral artery occlusion/reperfusion (MCAO/R) model in SD rats to ascertain if VitD3 preconditioning mediates ERS and ferroptosis involving of p53 signaling. In this study, we observed that VitD3 can reduce infarction volume and cerebral edema, which leads to the improvement of nerve function. HE, Nissl and Tunel staining showed that VitD3 treatment significantly improved the morphology of neuronal cells and reduced their death. The expression and activation of Vitamin D receptor (VDR), PKR-like ER kinase (PERK), C/EBP-homologous protein (CHOP), p53, nuclear factor erythroid 2-related factor 2 (Nrf2), glutathione peroxidase 4 (GPX4) and reactive oxygen species (ROS) in the ischemic penumbral area were detected by real-time qPCR, Western-blotting and Elisa. The results showed that after VitD3 treatment, VDR increased, ERS-related indices (PERK, CHOP) significantly decreased and ferroptosis-related indices (Nrf2, GPX4) increased. As a VDRs antagonist, pyridoxal-5-phosphate (P5P) can partially block the neuroprotective effects of VitD3. Therefore, CIRI can induce ERS and ferroptosis in the ischemic penumbra area and VitD3 may ameliorate nerve damage in CIRI rats by up-regulating VDR, alleviating p53-associated ERS and ferroptosis.
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Affiliation(s)
- Ting Song
- Department of Neurology II, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Jian Li
- Department of Neurology II, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Yulei Xia
- Department of Neurology II, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Shuai Hou
- Emergency Department, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Xiaojun Zhang
- Department of Neurology II, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Yanqiang Wang
- Department of Neurology II, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China.
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Xiao M, Zhao X, Luo J, Zhu Z, Wei L, Li B, Ji Z, Wu Y, Pan S, Lin Z, Huang K. High Systemic Inflammatory Protein Index Is Associated with Clinically Ineffective Reperfusion in Acute Anterior Circulation Ischemic Stroke Patients Undergoing Endovascular Treatment. Mol Neurobiol 2024; 61:7707-7716. [PMID: 38427214 DOI: 10.1007/s12035-024-04068-w] [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: 08/04/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Nearly half of the patients undergoing endovascular treatment (EVT) do not have favorable outcomes despite successful recanalization of the occluded artery, which is also known as clinically ineffective reperfusion. We proposed a novel index-the systemic inflammatory protein index (SIPI), based on albumin, globulin, and C-reaction protein (CRP). We aimed to evaluate the relationship between inflammatory biomarkers at varying time points and the 90-day functional outcomes and investigate inflammatory biomarkers' dynamic changes during hospitalization in acute ischemic stroke (AIS) patients of anterior circulation undergoing EVT. We retrospectively recruited consecutive patients diagnosed with AIS of anterior circulation and treated with EVT from January 2018 to June 2022 in Nanfang Hospital. Albumin, globulin, and CRP were recorded on admission, 1 day, 3 days, and 7 days after EVT. An unfavorable functional outcome was defined as 90-day modified Rankin Scale (mRS) of 3-6. Albumin-to-globulin ratio (AGR), C-reactive protein-to-albumin ratio (CAR), and SIPI were calculated as follows: AGR = albumin/globulin; CAR = CRP/albumin; SIPI = CRP × globulin/albumin. A total of 238 consecutive anterior circulation AIS patients with EVT were included, among which 145 (60.9%) patients had unfavorable outcomes. After adjusting for confounding factors, admission globulin, admission AGR, 1-day AGR, 3-day albumin, 3-day CRP, 3-day CAR, 3-day SIPI, 7-day albumin, 7-day CRP, 7-day CAR, and 7-day SIPI showed an independent association with 90-day functional outcome. Of them, 3-day SIPI had the most robust discriminative ability with an area under the curve of 0.719 (CI 0.630-0.808, p < 0.001). There were differences in the dynamic change of inflammatory biomarkers between the subjects with favorable and unfavorable functional outcomes. Inflammatory biomarkers, including albumin, globulin, CRP, AGR, CAR, and SIPI, are independent predictors of 90-day unfavorable outcomes in anterior circulation AIS patients with EVT. SIPI of day 3 has the highest predictive value.
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Affiliation(s)
- Mengxuan Xiao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Xiaolin Zhao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Jiaqi Luo
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Zhiliang Zhu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Lihua Wei
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Bingbing Li
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Zhong Ji
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Yongming Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.
| | - Zhenzhou Lin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.
| | - Kaibin Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou North Avenue 1838#, Guangzhou, 510515, China.
- Department of Neurology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Meiguan Avenue 16#, Ganzhou, 341000, China.
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Chaiwisitkun A, Muengtaweepongsa S. Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis. World J Exp Med 2024; 14:95540. [PMID: 39312695 PMCID: PMC11372743 DOI: 10.5493/wjem.v14.i3.95540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/22/2024] [Accepted: 06/12/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration. AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients. METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized. RESULTS Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607). CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.
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Affiliation(s)
- Ausanee Chaiwisitkun
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
| | - Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
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Leveau CM, Riancho J, Shaman J, Santurtún A. Spatial analysis of ischemic stroke in Spain: the roles of accessibility to healthcare and economic development. CAD SAUDE PUBLICA 2024; 40:e00212923. [PMID: 39319949 PMCID: PMC11415051 DOI: 10.1590/0102-311xen212923] [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: 11/22/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 09/26/2024] Open
Abstract
Ischemic stroke is a major cause of mortality worldwide; however, few studies have been conducted to measure the impact of the distribution of healthcare services on ischemic stroke fatality. This study aimed to explore the relationship between three ischemic stroke outcomes (incidence, mortality, and fatality) and accessibility to hospitals in Spain, considering its economic development. A cross-sectional ecological study was performed using data on hospital admissions and mortality due to ischemic stroke during 2016-2018. Gross geographic product (GGP) per capita was estimated and a healthcare accessibility index was created. A Besag-York-Mollié autoregressive spatial model was used to estimate the magnitude of association between ischemic stroke outcomes and economic development and healthcare accessibility. GGP per capita showed a geographical gradient from southwest to northeast in Spain. Mortality and case-fatality rates due to ischemic stroke were higher in the south of the country in both women and men aged 60+ years. In women and men aged 20-59 years a EUR 1,000 increase in GGP per capita was associated with decreases in mortality of 5% and 4%, respectively. Fatality decreased 3-4% with each EUR 1,000 increase of GGP per capita in both sexes and in the 20-59 and 60+ age groups. Decreased healthcare accessibility was associated with higher fatality in the population aged 60+. Economic development in southwest Spain would not only improve employment opportunities but also reduce ischemic stroke mortality. New health related strategies to improve hospital accessibility should be considered in more sparsely populated regions or those with worse transport and/or healthcare infrastructure.
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Affiliation(s)
- Carlos Marcelo Leveau
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús, Remedios de Escalada, Argentina
| | - Javier Riancho
- Hospital Sierrallana, Universidad de Cantabria, Santander, España
- Universidad de Cantabria, Santander, España
- Instituto de Investigación Marqués de Valdecilla, Santander, España
| | | | - Ana Santurtún
- Universidad de Cantabria, Santander, España
- Instituto de Investigación Marqués de Valdecilla, Santander, España
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Jing K, Gu R, Chen F, Wan J, Sun Y, Guo P, Chen F, Feng J, Guo J, Liu X. Orosomucoid 2 is an endogenous regulator of neuronal mitochondrial biogenesis and promotes functional recovery post-stroke. Pharmacol Res 2024; 209:107422. [PMID: 39293585 DOI: 10.1016/j.phrs.2024.107422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 09/01/2024] [Accepted: 09/15/2024] [Indexed: 09/20/2024]
Abstract
Development of functional recovery therapies is critical to reduce the global impact of stroke as the leading cause of long-term disability. Our previous studies found that acute-phase protein orosomucoid (ORM) could provide an up to 6h therapeutic time window to reduce infarct volume in acute ischemic stroke by improving endothelial function. However, its role in neurons and functional recovery post-stroke remains largely unknown. Here, we showed that exogenous ORM administration with initial injection at 0.5h (early) or 12h (delayed) post-MCAO daily for consecutive 7 days significantly decreased infarct area, improved motor and cognitive functional recovery, and promoted mitochondrial biogenesis after MCAO. While neuron-specific knockout of ORM2, a dominant subtype of ORM in the brain, produced opposite effects which could be rescued by exogenous ORM. In vitro, exogenous ORM protected SH-SY5Y cells from OGD-induced damage and promoted mitochondrial biogenesis, while endogenous ORM2 deficiency worsened these processes. Mechanistically, inactivation of CCR5 or AMPK eliminated the protective effects of ORM on neuronal damage and mitochondrial biogenesis. Taken together, our findings demonstrate that ORM, mainly ORM2, is an endogenous regulator of neuronal mitochondrial biogenesis by activating CCR5/AMPK signaling pathway, and might act as a potential therapeutic target for the functional recovery post-stroke.
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Affiliation(s)
- Kai Jing
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Ruinan Gu
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Feng Chen
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jingjing Wan
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Yang Sun
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Pengyue Guo
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Fei Chen
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jiayi Feng
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jinmin Guo
- Department of Clinical Pharmacy, 960(th) Hospital of Joint Logistic Support Force, Shandong, Jinan, China.
| | - Xia Liu
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China.
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Haj Mohamad Ebrahim Ketabforoush A, Hosseinpour A, Habibi MA, Ariaei A, Farajollahi M, Chegini R, Mirzaasgari Z. Optimizing Acute Ischemic Stroke Outcomes: The Role of Tenecteplase Before Mechanical Thrombectomy. Clin Ther 2024:S0149-2918(24)00223-6. [PMID: 39266330 DOI: 10.1016/j.clinthera.2024.08.014] [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: 03/16/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE Acute ischemic stroke (AIS) is a life-threatening condition demanding prompt reperfusion to salvage brain tissue. Thrombolytic drugs, like tenecteplase (TNK), offer clot dissolution, but time constraints and contraindications limit their use. Mechanical thrombectomy (MT) revolutionized AIS treatment, especially for large vessel occlusions (LVO). Recent evidence suggests that administering TNK before MT improves recanalization and outcomes, challenging the dominance of alteplase. METHODS Relevant articles focusing on TNK before MT were retrieved from PubMed, Scopus, and Web of Science, looking for randomized controlled trials (RCT), clinical trials, and meta-analyses in humans until 2024. FINDINGS TNK, a genetically engineered thrombolytic, exhibits superior fibrin specificity and a longer half-life than alteplase. Clinical trials comparing TNK and alteplase before MT showcase enhanced recanalization, functional outcomes, and safety with TNK. Advanced neuroimaging aids patient selection, though its cost-effectiveness warrants consideration. Dosing studies favor a 0.25 mg/kg dose for efficacy and reduced complications. Clinical guidelines from various associations acknowledge TNK's potential as an alteplase alternative for AIS treatment, particularly for LVOs eligible for thrombectomy. IMPLICATIONS In conclusion, TNK emerges as a promising option for bridging therapy in AIS, displaying efficacy and safety benefits, especially when administered before MT. Its fibrin specificity, longer half-life, and potential for improved outcomes position TNK as a viable alternative to alteplase, potentially transforming the landscape of AIS treatment strategies. While limitations like small sample sizes and variations in protocols exist, future research should focus on large-scale RCT, subgroup analyses, and cost-effectiveness evaluations to further elucidate TNK's role in optimizing AIS management.
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Affiliation(s)
| | - Ali Hosseinpour
- Department of Neurology, Clinical Research Development Unit (CRDU) of Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohamad Amin Habibi
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Armin Ariaei
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Rojin Chegini
- Metabolic liver disease research center, Isfahan University of medical sciences, Isfahan, Iran
| | - Zahra Mirzaasgari
- Department of Neurology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Chen R, Qian L, Zhang Q, Qin J, Chen X, Xu X. SMP30 alleviates cerebral ischemia/reperfusion-induced neuronal injury by inhibiting HDAC4/PSD-95 to preserve mitochondrial function. J Neuropathol Exp Neurol 2024:nlae095. [PMID: 39254519 DOI: 10.1093/jnen/nlae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Ischemic stroke is a major cause of global death and permanent disability. Major consequences of ischemic stroke include neuronal mitochondrial dysfunction. We investigated the effects of senescence marker protein 30 (SMP30) on mitochondria-mediated apoptosis and histone deacetylase 4 (HDAC4)/postsynaptic density-95 (PSD-95) signaling in stroke models in vivo and in vitro. Rats with middle cerebral artery occlusion/reperfusion (MCAO/R) were used to simulate cerebral ischemia/reperfusion (I/R) injury. SMP30 was downregulated in the brain tissues of rats after I/R induction. SMP30 overexpression decreased MCAO/R-induced infarct volumes and improved neurologic function and histopathological changes. Increasing SMP30 expression suppressed neuronal apoptosis and reduced mitochondrial dysfunction. SMP30 overexpression in SH-SY5Y and PC12 cells treated with oxygen-glucose deprivation/reoxygenation (OGD/R) decreased HDAC4 and PSD-95 expression; PSD-95 could bind to HDAC4. Furthermore, HDAC4 upregulation abolished the effects of SMP30 overexpression on OGD/R-induced apoptosis and mitochondrial dysfunction in SH-SY5Y cells. Together, these findings indicate that SMP30 alleviates cerebral I/R-induced neuronal injury by inhibiting HDAC4/PSD-95 to preserve mitochondrial function. These interactions might provide new treatment methods for patients with ischemic stroke.
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Affiliation(s)
- Rundong Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Qian
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qian Zhang
- Gerontology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jiajun Qin
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xianzhen Chen
- Department of Neurosurgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaolong Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
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11
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Tang H, Xing X, Han Y, Gao D, Chan P, Zhang S, Xue H. A Retrospective Study of Brain-Heart Syndrome in Patients with Acute Cerebrovascular Diseases. Risk Manag Healthc Policy 2024; 17:2161-2168. [PMID: 39263551 PMCID: PMC11389706 DOI: 10.2147/rmhp.s467205] [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: 03/04/2024] [Accepted: 08/01/2024] [Indexed: 09/13/2024] Open
Abstract
Objective To investigate the clinical characteristics, risk factors and outcomes of brain-heart syndrome (BHS) in patients with acute cerebrovascular diseases (ACVDs). Methods A retrospective analysis was conducted of 100 patients who were admitted to our hospital with ACVDs between January 2023 and December 2023. The demographic, clinical, laboratory and imaging data of the patients were collected, and the presence and severity of BHS were evaluated. The neurological and cardiac outcomes of the patients at discharge and at 12-month follow-up were also assessed. Results Out of the 100 patients, 38% had BHS, classified as mild (18%), moderate (12%) and severe (8%). The most prevalent ACVDs were cerebral infarction (58%), cerebral haemorrhage (32%) and subarachnoid haemorrhage (10%). Cardiac complications included arrhythmia (26%), myocardial ischaemia (18%) and heart failure (10%). Patients with BHS had higher results for blood pressure, heart rate, white blood cell count, C-reactive protein, IL-6, D-dimer and troponin, more severe neurological deficits, higher mortality and poorer functional outcomes. Multivariable analysis identified age, hypertension, diabetes, coronary artery disease, prior cardiovascular events, cerebral haemorrhage, brainstem infarction and hypothalamic or insular lesions as independent risk factors for BHS. Conclusion Brain-heart syndrome is a frequent, severe complication in patients with ACVD, linked with multiple risk factors and poor prognosis. Prompt diagnosis and treatment are crucial for improving patient outcomes.
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Affiliation(s)
- Hui Tang
- Department of Emergency Internal Medicine, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Xiurong Xing
- Department of Emergency Internal Medicine, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Yingna Han
- Department of Emergency Internal Medicine, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Daiquan Gao
- Department of Neurology, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Piu Chan
- Department of Neurobiology, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Shengfang Zhang
- School of Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Huixin Xue
- School of Medicine, Capital Medical University, Beijing, People's Republic of China
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Yang XY, Wang SL, Xue WC, Zhang YP, Li LL, Luo ZH, Zhang FJ. Nattokinase's Neuroprotective Mechanisms in Ischemic Stroke: Targeting Inflammation, Oxidative Stress, and Coagulation. Antioxid Redox Signal 2024. [PMID: 39135387 DOI: 10.1089/ars.2023.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Aims: Nattokinase (NK), a potent serine endopeptidase, has exhibited a variety of pharmacological effects, including thrombolysis, anti-inflammation, and antioxidative stress. Building on previous research highlighting NK's promise in nerve regeneration, our study investigated whether NK exerted protective effects in transient middle cerebral artery occlusion (tMCAO)-induced cerebral ischemia-reperfusion injury and the underlying mechanisms. Results: The rats were administered NK (5000, 10000, 20000 FU/kg, i.g., 7 days before surgery, once daily). We showed that NK treatment dose dependently reduced the infarction volume and improved neurological symptoms, decreased the proinflammatory and coagulation cytokines levels, and attenuated reactive oxygen species (ROS) in the infarcted area of tMCAO rats. We also found that NK could exert neuroprotective effects in a variety of vitro models, including the microglia inflammation model and neuronal oxygen-glucose deprivation/reperfusion (OGD/R) model. Notably, NK effectively countered OGD/R-induced neuron death, modulating diverse pathways, including autophagy, apoptosis, PARP-dependent death, and endoplasmic reticulum stress. Furthermore, the neuroprotection of NK was blocked by phenylmethylsulfonyl fluoride (PMSF), a serine endopeptidase inhibitor. We revealed that heat-inactive NK was unable to protect against tMCAO injury and other vitro models, suggesting NK attenuated ischemic injury by its enzymatic activity. We conducted a proteomic analysis and found inflammation and coagulation were involved in the occurrence of tMCAO model and in the therapeutic effect of NK. Innovation and Conclusion: In conclusion, these data demonstrated that NK had multifaceted neuroprotection in ischemic brain injury, and the therapeutic effect of NK was related with serine endopeptidase activity.
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Affiliation(s)
- Xin-Ying Yang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Sheng-Lin Wang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Wen-Chi Xue
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Yu-Peng Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Liang-Liang Li
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhao-Hu Luo
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Feng-Jiao Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
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13
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Tang Z, Xu B, Wang J, Wang W, Sha S, Sun Y. Novel metabolic biomarkers for the diagnosis of acute ischemic stroke. Biomark Med 2024:1-11. [PMID: 39235047 DOI: 10.1080/17520363.2024.2389033] [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: 11/19/2023] [Accepted: 07/29/2024] [Indexed: 09/06/2024] Open
Abstract
Aim: To identify novel metabolic biomarkers for patients with acute ischemic stroke (AIS).Methods: The metabolites in the sera of 63 patients with AIS aged 45∼77 years and 60 healthy individuals were analyzed by liquid chromatography (LC)-mass spectrometry (MS)/MS. The efficiency of significantly altered metabolites as biomarkers of AIS was evaluated by ROC curve analysis.Results: Different metabolic profiles were revealed in AIS patients' sera compared with healthy persons. Twelve significantly altered metabolites had an area under the curve (AUC) value >0.80, demonstrating their potential as a biomarker of AIS. Among them, six metabolites are firstly reported to distinguish between AIS patients and healthy individuals.Conclusion: These 12 metabolites can be further researched as potential diagnostic biomarkers of AIS.
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Affiliation(s)
- Zhenzhen Tang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Baoli Xu
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Junjun Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Wenzhen Wang
- Department of Biochemistry & Molecular Biology, Dalian Medical University, Dalian, 116044, China
| | - Shanshan Sha
- Department of Biochemistry & Molecular Biology, Dalian Medical University, Dalian, 116044, China
| | - Yongjin Sun
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
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Lens C, Demeestere J, Casolla B, Christensen H, Fischer U, Kelly P, Molina C, Sacco S, Sandset EC, Strbian D, Thomalla G, Tsivgoulis G, Vanhaecht K, Weltens C, Coeckelberghs E, Lemmens R. From guidelines to clinical practice in care for ischaemic stroke patients: A systematic review and expert opinion. Eur J Neurol 2024:e16417. [PMID: 39236303 DOI: 10.1111/ene.16417] [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: 04/09/2024] [Revised: 06/25/2024] [Accepted: 07/07/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND AND PURPOSE Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance. METHODS A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9-point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts. RESULTS Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non-invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed. DISCUSSION AND CONCLUSION Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility.
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Affiliation(s)
- Charlotte Lens
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
| | - Jelle Demeestere
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Barbara Casolla
- Université Cote d'Azur UR2CA-URRIS, Unité Neurovasculaire, CHU Hôpital Pasteur 2, Nice, France
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Neurology Department, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Peter Kelly
- Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
- Department of Neurology, Mater University Hospital, Dublin, Ireland
| | - Carlos Molina
- Stroke Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Simona Sacco
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georgios Tsivgoulis
- Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kris Vanhaecht
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Coeckelberghs
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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Shi P, Zheng B, Zhang S, Guo Q. A review of the sources and pharmacological research of morroniside. Front Pharmacol 2024; 15:1423062. [PMID: 39301568 PMCID: PMC11411571 DOI: 10.3389/fphar.2024.1423062] [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: 04/26/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
Introduction Morroniside (Mor) is a bioactive compound found in Corni Fructus (CF) [Cornaceae; Cornus officinalis Siebold & Zucc.], which has been used as medicine and food in China, Korea, and Japan for over 2,000 years. This review summarizes recent progress on Mor, specifically focusing on its distribution, isolation, detection, and various pharmacological effects. Methods A literature survey on Mor was conducted using electronic databases such as PubMed, ScienceDirect, CNKI, and Google Scholar. After removing TCM prescription-related standards, medicinal herb processing-related research, and other irrelevant works of literature, we obtained relevant information on Mor's biological and pharmacological properties. Results The main conclusions are as follows: Mor is widely distributed in the plant kingdom; the methods for extracting and isolating Mor are well established; and the technology for detecting it is accurate. Mor exhibits numerous pharmacological effects. Along with CF, Mor has shown renoprotective effects against diabetes, hepatoprotective effects against diabetes, triptolide, and nonalcoholic steatohepatitis, and boneprotective effects against osteoporosis and osteoarthritis. In addition, researchers have also explored other pharmacological effects of Mor, including neuroprotective effects against focal cerebral ischemia, spinal cord injury, and Alzheimer's disease; cardioprotective effects against acute myocardial infarction; protection of the digestive system from gastritis, inflammatory bowel disease, and colitis; protection of the skin by promoting hair growth, wound healing, and flap survival; and protection of the lungs from acute lung injury and pulmonary fibrosis. Moreover, Mor has anti-obesity effects, anti-inflammatory effects in the eye, and improves follicular development. Discussion Overall, this review provides a comprehensive understanding of the pharmacological effects of Mor, from which the limitations of the current research can be understood, which will help facilitate future research.
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Affiliation(s)
- Pengliang Shi
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Bingqing Zheng
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shiyao Zhang
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingmei Guo
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
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Härkönen H, Myllykangas K, Gomes J, Immonen M, Kärppä M, Hyvämäki P, Jansson M. Challenges and needs in cerebrovascular disease pathway: A qualitative descriptive study from the patients' and healthcare professionals' perspectives. J Adv Nurs 2024; 80:3767-3780. [PMID: 38214101 DOI: 10.1111/jan.16055] [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: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024]
Abstract
AIM(S) To understand patients' and healthcare professionals' experiences to improve care in and across different domains of the cerebrovascular disease pathway. DESIGN A qualitative descriptive study. METHODS Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and 26 healthcare professionals taking care of them in a single tertiary-level hospital from August 2021 to March 2022. Data were analysed using deductive and inductive content analysis. The consolidated criteria for reporting qualitative research was used to ensure reliable reporting. RESULTS Overall, 19 generic and 79 sub-categories describing perceived challenges with 17 generic and 62 sub-categories describing perceived needs were identified related to primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment, and life after stroke. CONCLUSION Several challenges and needs were identified in and across the different domains of the cerebrovascular disease pathway. There is a requirement for adequate resources, early initiation of treatment, early diagnostics and recanalization, dedicated rehabilitation services, long-term counselling and support, and impact evaluation of services to improve cerebrovascular disease care. Future research on caregivers', and clinical leadership experiences in and across the cerebrovascular disease pathway is needed to explore the provision of services. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The results of this study can be applied by organizations, managers and research for developing and improving services in the cerebrovascular disease pathway. IMPACT This study identified several patient-related, organizational and logistical needs and challenges, with suggestions for required actions, that can benefit the provision of effective, high-quality cerebrovascular disease care. REPORTING METHOD We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Henna Härkönen
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
| | - Kirsi Myllykangas
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
| | | | - Milla Immonen
- VTT Technical Research Centre of Finland, Oulu, Finland
| | - Mikko Kärppä
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, Neurology, University of Oulu/Faculty of Medicine, Oulu, Finland
| | - Piia Hyvämäki
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
- RMIT University, Melbourne, Victoria, Australia
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Talana ALE, Guirguis KB, Matthews JA, Chojecka PA, Chapman S, Koenig MA. A Rural Community Readiness Assessment of Prehospital Telestroke Services in the Ambulance. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:250-256. [PMID: 39290533 PMCID: PMC11402793 DOI: 10.62547/vzqv6670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
The research team assessed community acceptability of prehospital stroke telemedicine services in rural O'ahu communities. Tools were developed to evaluate patient-centered goals about implementing ambulance-based telemedicine which aimed to retain appropriate patients in community hospitals and improve thrombolytic treatment times. Using a mixed methods approach, the team surveyed well-appearing adults (ie, able to complete survey and interview) at O'ahu community events. Participants were asked to complete a short Likert-scale questionnaire (n=263) followed by a semi-structured interview (n=29). Data were summarized by descriptive and inferential statistics. Comparisons between rural and urban groups were made by chi-square analysis and Wilcoxon rank-sum 2-tailed test. Interviews were transcribed, coded, and analyzed using inductive and deductive methods. The findings suggest that use of prehospital telemedicine for specialty care is viewed favorably by both rural and urban respondents. Additionally, most respondents felt comfortable staying at their local hospital if they had access to a specialist by telemedicine. However, mistrust in rural hospitals may be a potential barrier to implementation. Compared to urban respondents, rural respondents were less confident in their local hospital's resources and capabilities for stroke care. The findings identified a potential misalignment of the project's goal with some patients' goal to use emergency medical services (EMS) to bypass rural hospitals for stroke care. Future community outreach efforts are needed to encourage activation of EMS and highlight the advantages of utilizing prehospital telemedicine for accessing specialty care thereby improving treatment times.
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Affiliation(s)
| | | | - J Aaron Matthews
- The Queen's Medical Center, Honolulu, HI (ALET, KBG, AM, PAC, MAK)
| | - Pola A Chojecka
- The Queen's Medical Center, Honolulu, HI (ALET, KBG, AM, PAC, MAK)
| | - Sherita Chapman
- Richmond VA Medical Center, Richmond, VA (SC)
- University of Virginia School of Medicine, Charlottesville, VA (SC)
| | - Matthew A Koenig
- The Queen's Medical Center, Honolulu, HI (ALET, KBG, AM, PAC, MAK)
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18
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Chen Y, He W, Qiu J, Luo Y, Jiang C, Zhao F, Wei H, Meng J, Long T, Zhang X, Yang L, Xu Q, Wang J, Zhang C. Pterostilbene improves neurological dysfunction and neuroinflammation after ischaemic stroke via HDAC3/Nrf1-mediated microglial activation. Cell Mol Biol Lett 2024; 29:114. [PMID: 39198723 PMCID: PMC11360871 DOI: 10.1186/s11658-024-00634-1] [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: 05/24/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Stroke is a type of acute brain damage that can lead to a series of serious public health challenges. Demonstrating the molecular mechanism of stroke-related neural cell degeneration could help identify a more efficient treatment for stroke patients. Further elucidation of factors that regulate microglia and nuclear factor (erythroid-derived 2)-like 1 (Nrf1) may lead to a promising strategy for treating neuroinflammation after ischaemic stroke. In this study, we investigated the possible role of pterostilbene (PTS) in Nrf1 regulation in cell and animal models of ischaemia stroke. METHODS We administered PTS, ITSA1 (an HDAC activator) and RGFP966 (a selective HDAC3 inhibitor) in a mouse model of middle cerebral artery occlusion-reperfusion (MCAO/R) and a model of microglial oxygen‒glucose deprivation/reperfusion (OGD/R). The brain infarct size, neuroinflammation and microglial availability were also determined. Dual-luciferase reporter, Nrf1 protein stability and co-immunoprecipitation assays were conducted to analyse histone deacetylase 3 (HDAC3)/Nrf1-regulated Nrf1 in an OGD/R-induced microglial injury model. RESULTS We found that PTS decreased HDAC3 expression and activity, increased Nrf1 acetylation in the cell nucleus and inhibited the interaction of Nrf1 with p65 and p65 accumulation, which reduced infarct volume and neuroinflammation (iNOS/Arg1, TNF-α and IL-1β levels) after ischaemic stroke. Furthermore, the CSF1R inhibitor PLX5622 induced elimination of microglia and attenuated the therapeutic effect of PTS following MCAO/R. In the OGD/R model, PTS relieved OGD/R-induced microglial injury and TNF-α and IL-1β release, which were dependent on Nrf1 acetylation through the upregulation of HDAC3/Nrf1 signalling in microglia. However, the K105R or/and K139R mutants of Nrf1 counteracted the impact of PTS in the OGD/R-induced microglial injury model, which indicates that PTS treatment might be a promising strategy for ischaemia stroke therapy. CONCLUSION The HDAC3/Nrf1 pathway regulates the stability and function of Nrf1 in microglial activation and neuroinflammation, which may depend on the acetylation of the lysine 105 and 139 residues in Nrf1. This mechanism was first identified as a potential regulatory mechanism of PTS-based neuroprotection in our research, which may provide new insight into further translational applications of natural products such as PTS.
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Affiliation(s)
- Yuhua Chen
- Department of Neurosurgery, Academy of Traditional Chinese Medicine, Bijie Traditional Chinese Medicine Hospital, Bijie, 551700, China
- Department of Medical Science Research Center, Peihua University, Xi'an, 710125, Shaanxi, China
| | - Wei He
- Department of Neurosurgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266000, Shandong, China
| | - Junlin Qiu
- Department of Cardiology, First Hospital of Northwestern University, Xi'an, 710043, Shaanxi, China
| | - Yangyang Luo
- School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Chenlong Jiang
- School of Life Sciences, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Feng Zhao
- Department of Sport Medicine, Sports Medicine Institute, Peking University Third Hospital, Beijing, 100191, China
| | - Hong Wei
- Department of Neurosurgery, Academy of Traditional Chinese Medicine, Bijie Traditional Chinese Medicine Hospital, Bijie, 551700, China
| | - Jiao Meng
- Department of Neurosurgery, Academy of Traditional Chinese Medicine, Bijie Traditional Chinese Medicine Hospital, Bijie, 551700, China
- Department of Medical Science Research Center, Peihua University, Xi'an, 710125, Shaanxi, China
| | - Tianlin Long
- Department of Neurosurgery, Academy of Traditional Chinese Medicine, Bijie Traditional Chinese Medicine Hospital, Bijie, 551700, China
| | - Xin Zhang
- Department of Neurosurgery, Academy of Traditional Chinese Medicine, Bijie Traditional Chinese Medicine Hospital, Bijie, 551700, China
| | - Lingjian Yang
- School of Chemistry & Chemical Engineering, Ankang University, Ankang, 725000, China
| | - Quanhua Xu
- Department of Neurosurgery, Academy of Traditional Chinese Medicine, Bijie Traditional Chinese Medicine Hospital, Bijie, 551700, China
| | - Juning Wang
- Department of Medical Science Research Center, Peihua University, Xi'an, 710125, Shaanxi, China
| | - Chi Zhang
- Department of Neurosurgery, The Institute of Skull Base Surgery and Neurooncology at Hunan Province, Xiangya Hospital, Central South University, NO. 87 Xiangya Road, Changsha, 410008, China.
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Wang X, Luo S, Cui X, Qu H, Zhao Y, Liao Q. Machine learning-based predictive model for the development of thrombolysis resistance in patients with acute ischemic stroke. BMC Neurol 2024; 24:296. [PMID: 39187795 PMCID: PMC11346215 DOI: 10.1186/s12883-024-03781-2] [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: 03/05/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The objective of this study was to establish a predictive model utilizing machine learning techniques to anticipate the likelihood of thrombolysis resistance (TR) in acute ischaemic stroke (AIS) patients undergoing recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis, given that nearly half of such patients exhibit poor clinical outcomes. METHODS Retrospective clinical data were collected from AIS patients who underwent intravenous thrombolysis with rt-PA at the First Affiliated Hospital of Bengbu Medical University. Thrombolysis resistance was defined as ([National Institutes of Health Stroke Scale (NIHSS) at admission - 24-hour NIHSS] × 100%/ NIHSS at admission) ≤ 30%. In this study, we developed five machine learning models: logistic regression (LR), extreme gradient boosting (XGBoost), support vector machine (SVM), the least absolute shrinkage and selection operator (LASSO), and random forest (RF). We assessed the model's performance by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), and presented the results through a nomogram. RESULTS This study included a total of 218 patients with AIS who were treated with intravenous thrombolysis, 88 patients experienced TR. Among the five machine learning models, the LASSO model performed the best. The area under the curve (AUC) on the testing group was 0.765 (sensitivity: 0.767, specificity: 0.694, accuracy: 0.727). The apparent curve in the calibration curve was similar to the ideal curve, and DCA showed a positive net benefit. Key features associated with TR included NIHSS at admission, blood glucose, white blood cell count, neutrophil count, and blood urea nitrogen. CONCLUSION Machine learning methods with multiple clinical variables can help in early screening of patients at high risk of thrombolysis resistance, particularly in contexts where healthcare resources are limited.
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Affiliation(s)
- Xiaorui Wang
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Song Luo
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China.
| | - Xue Cui
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Hongdang Qu
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Yujie Zhao
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
| | - Qirong Liao
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233004, China
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20
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Gu H, Yan Y, He X, Xu Y, Wei Y, Shao Y. Predicting the clinical prognosis of acute ischemic stroke using machine learning: an application of radiomic biomarkers on non-contrast CT after intravascular interventional treatment. Front Neuroinform 2024; 18:1400702. [PMID: 39239071 PMCID: PMC11374607 DOI: 10.3389/fninf.2024.1400702] [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: 03/14/2024] [Accepted: 07/26/2024] [Indexed: 09/07/2024] Open
Abstract
Purpose This study aimed to develop a radiomic model based on non-contrast computed tomography (NCCT) after interventional treatment to predict the clinical prognosis of acute ischemic stroke (AIS) with large vessel occlusion. Methods We retrospectively collected 141 cases of AIS from 2016 to 2020 and analyzed the patients' clinical data as well as NCCT data after interventional treatment. Then, the total dataset was divided into training and testing sets according to the subject serial number. The cerebral hemispheres on the infarct side were segmented for radiomics signature extraction. After radiomics signatures were standardized and dimensionality reduced, the training set was used to construct a radiomics model using machine learning. The testing set was then used to validate the prediction model, which was evaluated based on discrimination, calibration, and clinical utility. Finally, a joint model was constructed by incorporating the radiomics signatures and clinical data. Results The AUCs of the joint model, radiomics signature, NIHSS score, and hypertension were 0.900, 0.863, 0.727, and 0.591, respectively, in the training set. In the testing set, the AUCs of the joint model, radiomics signature, NIHSS score, and hypertension were 0.885, 0.840, 0.721, and 0.590, respectively. Conclusion Our results provided evidence that using post-interventional NCCT for a radiomic model could be a valuable tool in predicting the clinical prognosis of AIS with large vessel occlusion.
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Affiliation(s)
- Hongxian Gu
- Department of Radiology, The People's Hospital of Jianyang City, Jianyang, Sichuan Province, China
| | - Yuting Yan
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Xiaodong He
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Yuyun Xu
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Yuguo Wei
- GE Healthcare Life Sciences, Hangzhou, Jiangsu, China
| | - Yuan Shao
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
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Chen X, Li A, Zhou W, Yao L. No genetic association between iron deficiency anemia and ischemic stroke and its subtypes: a bidirectional two-sample Mendelian randomization study. Front Neurol 2024; 15:1408758. [PMID: 39228510 PMCID: PMC11369898 DOI: 10.3389/fneur.2024.1408758] [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: 03/28/2024] [Accepted: 08/08/2024] [Indexed: 09/05/2024] Open
Abstract
Background Observational researches have suggested a connection between iron deficiency anemia (IDA) and an increased likelihood of ischemic stroke (IS), yet establishing causality is challenging owing to the inherent limitations of such studies, including their vulnerability to confounding factors and the potential for reverse causation. This study employs a bidirectional two-sample Mendelian randomization (MR) approach to assess the causal linkage between IDA and IS and its subtypes. Methods Identifiable single nucleotide polymorphisms (SNPs) with significant links to either IDA or IS and its subtypes were employed as instrumental variables (IVs). The relationship between IDA and any IS, small vessel stroke (SVS), cardioembolic stroke (CES), and large artery stroke (LAS), was quantified using the inverse variance weighted (IVW) method. Complementary analyses utilizing MR-Egger and weighted median methods further supplemented the IVW findings. Moreover, the leave-one-out analysis, MR-Egger intercept test, MR-PRESSO global test, and Cochrane's Q test were conducted for sensitivity analyses. Results This study revealed no correlation between IDA and any IS (IVW method: OR [95% CI] = 0.977 [0.863-1.106]; p = 0.716), LAS (OR [95% CI] = 1.158 [0.771-1.740]; p = 0.479), CES (OR [95% CI] = 1.065 [0.882-1.285]; p = 0.512), or SVS (OR [95% CI] = 1.138 [0.865-1.498]; p = 0.357). Conducting a reverse MR analysis, it was determined that there is no causal connection between any IS, LAS, CES, SVS, and IDA (all p > 0.05). Sensitivity analysis indicated that heterogeneity was not significant and no evidence of horizontal pleiotropy was detected. Conclusion This MR study suggested no causal effect of IDA on IS, LAS, CES, and SVS. Through reverse MR analyses, it was determined that IS and its subtypes did not exert a causal impact on IDA.
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Affiliation(s)
- Xingyu Chen
- Department of Neurology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Aiping Li
- Department of Neurology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wensheng Zhou
- Department of Neurology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Liping Yao
- Department of Neurology, The Third Hospital of Changsha, Changsha, China
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Rahnama Sisakht A, Tavasouli Z, Negahi A, Hosseini SA, Satarzadeh M. Dental pulp stem cells regenerate neural tissue in degenerative disorders and stroke rehabilitation: A scope systematic review. Heliyon 2024; 10:e35080. [PMID: 39166055 PMCID: PMC11334686 DOI: 10.1016/j.heliyon.2024.e35080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
Background Dental Pulp Stem Cells (DPSCs) possess a remarkable ability for tissue differentiation, making them highly efficient in tissue regeneration and inflammation regulation. This systematic study proposes to find an answer to the question, "Do DPSCs have the ability to regenerate and rehabilitate nerve tissue?" Methods This systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and the principle of non-bias was respected. All the articles from 2014 to 2024 were extracted from the Web of Science, PubMed, and Scopus databases. This study extracted the antigens and pro-inflammatory factors associated with DPSCs' involvement and how they affect the CNS's neural tissue regeneration. Results Two persons of researchers searched the database. After screening the full texts, they included 11 articles in their study. DPSCs control the following antigens: CD73, CD34, CD90, CD105, CD14, CD45, CD19Oct-4, CD73, CD31, CD34CD29CD44. Even though hematopoietic markers did not change much, OCT-4 and CD-73 were increased by DPSCs. DPSC-derived exosomes suppressed the expression of IL-6, IL-1β, TNF-α, and TGF, key mediators of nerve tissue inflammation. Additionally, DPSCs show high Vascular Endothelial Growth Factor (VEGF) expression in mice brain tissue cultures. DPSCs reduce Subarachnoid Hemorrhage (SAH), a condition in which blood collects in the subarachnoid space and causes ischemia. Discussion DPSCs showed the ability to regenerate nerve tissue and brain ganglia, stimulating angiogenesis by expressing cell markers and controlling growth factors in mice, and high therapeutic potential in neurodegenerative disorders. The present study invites further research in neurological disorders, specifically strokes, to prescribe these stem cells to the human population.
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Affiliation(s)
| | - Zahra Tavasouli
- Ghaemieh Health Care Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Negahi
- School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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23
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Zhang ZZ, Nasir A, Li D, Khan S, Bai Q, Yuan F. Effect of dexmedetomidine on ncRNA and mRNA profiles of cerebral ischemia-reperfusion injury in transient middle cerebral artery occlusion rats model. Front Pharmacol 2024; 15:1437445. [PMID: 39170713 PMCID: PMC11335533 DOI: 10.3389/fphar.2024.1437445] [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: 05/23/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024] Open
Abstract
Ischemic stroke poses a significant global health burden, with rapid revascularization treatments being crucial but often insufficient to mitigate ischemia-reperfusion (I/R) injury. Dexmedetomidine (DEX) has shown promise in reducing cerebral I/R injury, but its potential molecular mechanism, particularly its interaction with non-coding RNAs (ncRNAs), remains unclear. This study investigates DEX's therapeutic effect and potential molecular mechanisms in reducing cerebral I/R injury. A transient middle cerebral artery obstruction (tMACO) model was established to simulate cerebral I/R injury in adult rats. DEX was administered pre-ischemia and post-reperfusion. RNA sequencing and bioinformatic analyses were performed on the ischemic cerebral cortex to identify differentially expressed non-coding RNAs (ncRNAs) and mRNAs. The sequencing results showed 6,494 differentially expressed (DE) mRNA and 2698 DE circRNA between the sham and tMCAO (I/R) groups. Additionally, 1809 DE lncRNA, 763 DE mRNA, and 2795 DE circRNA were identified between the I/R group and tMCAO + DEX (I/R + DEX) groups. Gene ontology (GO) analysis indicated significant enrichment in multicellular biogenesis, plasma membrane components, and protein binding. KEGG analysis further highlighted the potential mechanism of DEX action in reducing cerebral I/R injury, with hub genes involved in inflammatory pathways. This study demonstrates DEX's efficacy in reducing cerebral I/R injury and offers insights into its brain-protective effects, especially in ischemic stroke. Further research is warranted to fully understand DEX's neuroprotective mechanisms and its clinical applications.
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Affiliation(s)
- Zhen Zhen Zhang
- Department of Anesthesiology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Abdul Nasir
- Department of Anesthesiology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Medical Research Center, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dong Li
- Department of Anesthesiology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Suliman Khan
- Medical Research Center, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qian Bai
- Department of Anesthesiology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Medical Research Center, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Feng Yuan
- Department of Anesthesiology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Chen W, Li W, Wang Y, Chen D, Yu L, Yuan X. Evaluation of the knowledge, attitude and practice towards ischaemic stroke among healthcare workers in neurology and neurosurgery department: a cross-sectional study in Shaanxi province, China. BMJ Open 2024; 14:e086482. [PMID: 39107009 PMCID: PMC11308873 DOI: 10.1136/bmjopen-2024-086482] [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: 03/15/2024] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES Healthcare workers play an important role in the timely recognition and treatment of patients who had an ischaemic stroke. However, their knowledge, attitude and practice (KAP) towards ischaemic stroke have not been well studied. This study aimed to assess the KAP towards ischaemic stroke among healthcare workers in the neurology and neurosurgery department in Shaanxi province, China. DESIGN Cross-sectional study. SETTING Medical centres in Shaanxi province. PARTICIPANTS Healthcare workers in the neurology and neurosurgery department at Shaanxi province. PRIMARY AND SECONDARY OUTCOME MEASURES Demographic characteristics and KAP towards ischaemic stroke were collected by a self-designed questionnaire. RESULTS A total of 259 (96.6%) valid questionnaires were collected. Their mean KAP scores were 19.56±3.72 (total score: 23), 36.56±3.56 (total score: 40) and 27.45±3.00 (total score: 30), respectively. Multivariate logistic regression analysis demonstrated that education (bachelor's degree or above vs college or below: OR=2.704 (1.286-5.685), p=0.009), gender (female vs male: OR=0.401 (0.227-0.710), p=0.002) and professional title (intermediate vs no title: OR=0.280 (0.107-0.731), p=0.009) were independently associated with good knowledge; knowledge score (OR=1.266 (1.157-1.387), p<0.001) and hospital (private hospital vs public hospital: OR=0.544 (0.313-0.944), p=0.030) were independently associated with good attitude; and attitude score (OR=1.480 (1.326-1.652), p<0.001), gender (female vs male: OR=0.511 (0.264-0.993), p=0.047) and occupation (other healthcare workers vs physicians: OR=0.252 (0.129-0.495), p<0.001) were independently associated with good practice. CONCLUSION The healthcare workers in the neurology and neurosurgery department demonstrated a satisfactory KAP towards ischaemic stroke. Targeted and tailored training programmes might be an optional way to improve their practice.
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Affiliation(s)
- Wanhong Chen
- Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China
| | - Wenqiang Li
- Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China
| | - Yugang Wang
- Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China
| | - Dan Chen
- Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China
| | - Liping Yu
- Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China
| | - Xingyun Yuan
- Department of Neurology, The First People's Hospital of Xianyang, Xianyang, Shaanxi, China
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25
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Karmelić I, Rubić I, Starčević K, Ozretić D, Poljaković Z, Sajko MJ, Kalousek V, Kalanj R, Rešetar Maslov D, Kuleš J, Roje Bedeković M, Sajko T, Rotim K, Mrljak V, Fabris D. Comparative Targeted Metabolomics of Ischemic Stroke: Thrombi and Serum Profiling for the Identification of Stroke-Related Metabolites. Biomedicines 2024; 12:1731. [PMID: 39200198 PMCID: PMC11351249 DOI: 10.3390/biomedicines12081731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/02/2024] Open
Abstract
Ischemic stroke is one of the leading causes of death and permanent disability in the world. Rapid diagnosis and intervention are crucial for reducing its consequences on individuals and societies. Therefore, identifying reliable biomarkers for early detection, prognostics, and therapy can facilitate the early prediction and prevention of stroke. Metabolomics has been shown as a promising tool for biomarker discovery since many post-ischemic metabolites can be found in the plasma or serum of the patient. In this research, we performed a comparative targeted metabolomic analysis of stroke thrombi, stroke patient serums, and healthy control serums in order to determine the alteration in the patients' metabolomes, which might serve as biomarkers for early prediction or stroke prevention. The most statistically altered metabolites characterized in the patient serums compared with the control serums were glutamate and serotonin, followed by phospholipids and triacylglycerols. In stroke thrombi compared with the patients' serums, the most significantly altered metabolites were classified as lipids, with choline-containing phospholipids and sphingomyelins having the highest discriminatory score. The results of this preliminary study could help in understanding the roles of different metabolic changes that occur during thrombosis and cerebral ischemia and possibly suggest new metabolic biomarkers for ischemic stroke.
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Affiliation(s)
- Ivana Karmelić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Ivana Rubić
- Laboratory of Proteomics, Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - Katarina Starčević
- Department of Neurology, University Hospital Centre “Zagreb”, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - David Ozretić
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre “Zagreb”, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Zdravka Poljaković
- Department of Neurology, University Hospital Centre “Zagreb”, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Mia Jurilj Sajko
- Department of Neurosurgery, University Hospital Centre “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Vladimir Kalousek
- Department of Radiology, University Hospital Centre “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Rafaela Kalanj
- Department of Neurology, University Hospital Centre “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Dina Rešetar Maslov
- Laboratory of Proteomics, Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - Josipa Kuleš
- Department of Chemistry and Biochemistry, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - Marina Roje Bedeković
- Department of Neurology, University Hospital Centre “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Tomislav Sajko
- Department of Neurosurgery, University Hospital Centre “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Krešimir Rotim
- Department of Neurosurgery, University Hospital Centre “Sestre Milosrdnice”, Vinogradska cesta 29, 10000 Zagreb, Croatia
| | - Vladimir Mrljak
- Laboratory of Proteomics, Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova 55, 10000 Zagreb, Croatia
| | - Dragana Fabris
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
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26
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Guo F, Wang N, Yu C, Fan Y, Chen D. Genetic association between long non-coding RNA MIAT polymorphism and ischemic stroke susceptibility in the Chinese population. J Stroke Cerebrovasc Dis 2024; 33:107813. [PMID: 38871261 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107813] [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: 03/07/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES The genetic association of long non-coding RNAs (lncRNAs) polymorphism with ischemic stroke (IS) susceptibility is not fully understood. To explore whether lncRNA MIAT rs1894720 polymorphism can predict the susceptibility of IS in the Chinese Han population. MATERIALS AND METHODS 200 IS cases and 200 healthy controls were enrolled. Serum MIAT levels were tested via qRT-PCR. Rs1894720 genotyping was accomplished through Sanger sequencing. RESULTS MIAT rs1894720 genotypes were differentially distributed in IS and control groups. Rs1894720 TT genotype was considered to be a protective factor for IS risk in dominant model (GT + TT vs GG: OR = 0.630, 95 % CI = 0.412-0.962, P = 0.032). Further stratification results showed that individuals carrying the rs1894720 G allele in people older than 65 years, men, smokers, or those with hypertension had a higher risk of IS. MIAT rs1894720 GG genotype was positively related to the susceptibility to IS of LAA subtype compared with the healthy controls. GG genotype carriers had high serum MIAT levels compared to those with GT and TT genotypes. CONCLUSIONS MIAT rs1894720 polymorphism was associated with the risk of IS in the Chinese Han population, especially for LAA subtype. Rs1894720 GG genotype carriers were at greater risk of developing IS.
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Affiliation(s)
- Fengning Guo
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou 221000, China
| | - Nuan Wang
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou 221000, China
| | - Chunyu Yu
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou 221000, China
| | - Youmin Fan
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou 221000, China
| | - Dan Chen
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou 221000, China.
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27
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Li Y, Sun Y, Wang J, Wang X, Yang W. Voacangine protects hippocampal neuronal cells against oxygen-glucose deprivation/reoxygenation-caused oxidative stress and ferroptosis by activating the PI3K-Akt-FoxO signaling. J Appl Toxicol 2024; 44:1246-1256. [PMID: 38666302 DOI: 10.1002/jat.4615] [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: 02/17/2024] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 07/16/2024]
Abstract
Voacangine, a naturally occurring alkaloid, has been testified to display beneficial effects on a variety of human diseases, but its role in ischemic stroke is unclear. The impacts of voacangine on oxygen-glucose deprivation/reoxygenation (OGD/R)-tempted hippocampal neuronal cells are investigated. The bioinformatics analysis found that voacangine is a bioactive ingredient that may have good effects on ischemic stroke. KEGG pathways analysis found that voacangine may regulate ischemic stroke through modulating the PI3K-Akt-FoxO signaling pathway. Voacangine could mitigate OGD/R-tempted cytotoxicity in HT22 cells. Voacangine mitigated OGD/R-tempted oxidative stress in HT22 cells by diminishing reactive oxygen species level and enhancing superoxide dismutase level. Voacangine mitigated OGD/R-tempted ferroptosis in HT22 cells. Voacangine promoted activation of the PI3K-Akt-FoxO signaling in OGD/R-induced HT22 cells. Inactivation of the PI3K-Akt-FoxO signaling pathway reversed the protective effects of voacangine against OGD/R-tempted oxidative stress, cytotoxicity, and ferroptosis in HT22 cells. In conclusion, voacangine protects hippocampal neuronal cells against OGD/R-caused oxidative stress and ferroptosis by activating the PI3K-Akt-FoxO signaling.
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Affiliation(s)
- Ying Li
- Medical College, Zhengzhou University of Industrial Technology, No. 16 Xueyuan Road, Xinzheng, Henan Province, 451100, China
| | - Yan Sun
- Medical College, Zhengzhou University of Industrial Technology, No. 16 Xueyuan Road, Xinzheng, Henan Province, 451100, China
| | - Jianghong Wang
- Medical College, Zhengzhou University of Industrial Technology, No. 16 Xueyuan Road, Xinzheng, Henan Province, 451100, China
| | - Xiaolong Wang
- Medical College, Zhengzhou University of Industrial Technology, No. 16 Xueyuan Road, Xinzheng, Henan Province, 451100, China
| | - Wenjie Yang
- College of Public Health, Zhengzhou University, No. 164 Kexue Road, Zhengzhou, Henan Province, 450001, China
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28
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Wang Y, Li H, Sun H, Xu C, Sun H, Wei W, Song J, Jia F, Zhong D, Li G. A2 reactive astrocyte-derived exosomes alleviate cerebral ischemia-reperfusion injury by delivering miR-628. J Cell Mol Med 2024; 28:e70004. [PMID: 39159174 PMCID: PMC11332600 DOI: 10.1111/jcmm.70004] [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: 10/10/2023] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024] Open
Abstract
Ischemia and hypoxia activate astrocytes into reactive types A1 and A2, which play roles in damage and protection, respectively. However, the function and mechanism of A1 and A2 astrocyte exosomes are unknown. After astrocyte exosomes were injected into the lateral ventricle, infarct volume, damage to the blood-brain barrier (BBB), apoptosis and the expression of microglia-related proteins were measured. The dual luciferase reporter assay was used to detect the target genes of miR-628, and overexpressing A2-Exos overexpressed and knocked down miR-628 were constructed. qRT-PCR, western blotting and immunofluorescence staining were subsequently performed. A2-Exos obviously reduced the infarct volume, damage to the BBB and apoptosis and promoted M2 microglial polarization. RT-PCR showed that miR-628 was highly expressed in A2-Exos. Dual luciferase reporter assays revealed that NLRP3, S1PR3 and IRF5 are target genes of miR-628. After miR-628 was overexpressed or knocked down, the protective effects of A2-Exos increased or decreased, respectively. A2-Exos reduced pyroptosis and BBB damage and promoted M2 microglial polarization through the inhibition of NLRP3, S1PR3 and IRF5 via the delivery of miR-628. This study explored the mechanism of action of A2-Exos and provided new therapeutic targets and concepts for treating cerebral ischemia.
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Affiliation(s)
- Yingju Wang
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - He Li
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Hanwen Sun
- Department of EmergencyRui Jin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Chen Xu
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Hongxue Sun
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Wan Wei
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Jihe Song
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Feihong Jia
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Di Zhong
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
| | - Guozhong Li
- Department of NeurologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangPeople's Republic of China
- Department of NeurologyHeilongjiang Provincial HospitalHarbinHeilongjiangPeople's Republic of China
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29
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Luo E, Li Z, Zhang S, Wen Y, Yang Z, Zeng H, Ding H. Hyperglycemia induces microglial pyroptosis by increasing oxygen extraction rate: Implication in neurological impairment during ischemic stroke. Mol Med Rep 2024; 30:146. [PMID: 38940333 PMCID: PMC11222914 DOI: 10.3892/mmr.2024.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
Elevated levels of blood glucose in patients with ischemic stroke are associated with a worse prognosis. The present study aimed to explore whether hyperglycemia promotes microglial pyroptosis by increasing the oxygen extraction rate in an acute ischemic stroke model. C57BL/6 mice that underwent middle cerebral artery occlusion were used for assessment of blood glucose level and neurological function. The cerebral oxygen extraction ratio (CERO2), oxygen consumption rate (OCR) and partial pressure of brain tissue oxygen (PbtO2) were measured. To investigate the significance of the NOD‑like receptor protein 3 (NLRP3) inflammasome, NLRP3‑/‑ mice were used, and the expression levels of NLRP3, caspase‑1, full‑length gasdermin D (GSDMD‑FL), GSDMD‑N domain (GSDMD‑N), IL‑1β and IL‑18 were evaluated. In addition, Z‑YVAD‑FMK, a caspase‑1 inhibitor, was used to treat microglia to determine whether activation of the NLRP3 inflammasome was required for the enhancing effect of hyperglycemia on pyroptosis. It was revealed that hyperglycemia accelerated cerebral injury in the acute ischemic stroke model, as evidenced by decreased latency to fall and the percentage of foot fault. Hyperglycemia aggravated hypoxia by increasing the oxygen extraction rate, as evidenced by increased CERO2 and OCR, and decreased PbtO2 in response to high glucose treatment. Furthermore, hyperglycemia‑induced microglial pyroptosis was confirmed by detection of increased levels of caspase‑1, GSDMD‑N, IL‑1β and IL‑18 and a decreased level of GSDMD‑FL. However, the knockout of NLRP3 attenuated these effects. Pharmacological inhibition of caspase‑1 also reduced the expression levels of GSDMD‑N, IL‑1β and IL‑18 in microglial cells. These results suggested that hyperglycemia stimulated NLRP3 inflammasome activation by increasing the oxygen extraction rate, thus leading to the aggravation of pyroptosis following ischemic stroke.
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Affiliation(s)
- Ensi Luo
- Department of Endocrinology, Binhaiwan Central Hospital of Dongguan, Dongguan Hospital Affiliated to Medical College of Jinan University, Dongguan, Guangdong 523903, P.R. China
| | - Zhuo Li
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, P.R. China
| | - Shiying Zhang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, P.R. China
| | - Yin Wen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, P.R. China
| | - Zixi Yang
- College of Continuing Education, Guangdong Medical University, Zhanjiang, Guangdong 524023, P.R. China
| | - Hongke Zeng
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, P.R. China
| | - Hongguang Ding
- Department of Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, P.R. China
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30
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Lin Y, Liu M, Deng P, Zhang J. TET1 mediated m5C modification of RelB aggravates cerebral ischemia/reperfusion-induced neuroinflammation through regulating microglia polarization. Cell Signal 2024; 120:111210. [PMID: 38705503 DOI: 10.1016/j.cellsig.2024.111210] [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: 03/06/2024] [Revised: 04/11/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Microglia mediated neuroinflammation is one of the major contributors to brain damage in cerebral ischemia reperfusion injury (CI/RI). Recently, RNA modification was found to contribute to the regulation of microglia polarization and the subsequent development of cerebral I/R neuroinflammation. Herein, we investigated the effect and mechanism of m5C RNA modification in the microglia induced CI/RI neuroinflammation. We found that the m5C RNA modification levels decreased in the primary microglia isolated from a mouse model of intraluminal middle cerebral artery occlusion/reperfusion (MCAO/R) and the BV2 microglial cells subjected to oxygen-glucose deprivation and reoxygenation (OGD/R), and this change was accompanied by an increase in the M1/M2 polarization ratio. Furthermore, the expression of m5C demethylase TET1 in microglia increased, which promoted M1 polarization but impeded M2 polarization. Mechanistically, the higher TET1 expression decreased the m5C modification level of RelB and enhanced its mRNA stability, which subsequently increased the M1/M2 polarization ratio. In conclusion, this study provides insight into the role of m5C RNA modification in the pathogenesis of cerebral I/R neuroinflammation and may deepen our understanding on clinical therapy targeting the TET1-RelB axis.
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Affiliation(s)
- Yan Lin
- Department of Neurology, Sichuan Provincial People's Hospital, School of Medicine, University of Elctronic Science and Technology of China, 32 2rd Setion of Yihuan Road West, Qingyang District, Chengdu, 610072, Sichuan Province, China
| | - Mei Liu
- Department of Neurology, The Six People's Hospital of Chengdu, Chengdu, Sichuan Province 610072, China
| | - Pinghuan Deng
- Department of Encephalopathy, Dechang County Hospital of Traditional Chinese Medicine, Dechang, Sichuan Province 615500, China
| | - Jinzhi Zhang
- Department of Neurology, Sichuan Provincial People's Hospital, School of Medicine, University of Elctronic Science and Technology of China, 32 2rd Setion of Yihuan Road West, Qingyang District, Chengdu, 610072, Sichuan Province, China..
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Gu J, Huang W, Duanmu Z, Zhuang R, Yang X. Cuproptosis and copper deficiency in ischemic vascular injury and repair. Apoptosis 2024; 29:1007-1018. [PMID: 38649508 DOI: 10.1007/s10495-024-01969-y] [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] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
Ischemic vascular diseases are on the rise globally, including ischemic heart diseases, ischemic cerebrovascular diseases, and ischemic peripheral arterial diseases, posing a significant threat to life. Copper is an essential element in various biological processes, copper deficiency can reduce blood vessel elasticity and increase platelet aggregation, thereby increasing the risk of ischemic vascular disease; however, excess copper ions can lead to cytotoxicity, trigger cell death, and ultimately result in vascular injury through several signaling pathways. Herein, we review the role of cuproptosis and copper deficiency implicated in ischemic injury and repair including myocardial, cerebral, and limb ischemia. We conclude with a perspective on the therapeutic opportunities and future challenges of copper biology in understanding the pathogenesis of ischemic vascular disease states.
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Affiliation(s)
- Jiayi Gu
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Huang
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng Duanmu
- School of Instrument Science and Opto-Electronics Engineering of Beijing Information Science and Technology University, Beijing, China
| | - Rulin Zhuang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Xilan Yang
- Department of General Practice, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Zhang P, Cheng J, Liu C, Li W, Wang Y, Zhang N, Wu J, Zhang X, Liu C, Hou Y. Hypersensitive MR Angiography for Diagnosis of Ischemic Stroke and Reperfusion Subarachnoid Hemorrhage. Anal Chem 2024; 96:11742-11750. [PMID: 38980807 DOI: 10.1021/acs.analchem.4c01097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Stroke is an acute injury of the central nervous system caused by the disorders of cerebral blood circulation, which has become one of the major causes of disability and death. Hemorrhage, particularly subarachnoid hemorrhage (SAH), is one of the poorest prognostic factors in stroke, which is related to the thrombolytic therapy, and has been considered very dangerous. In this context, the MR angiography with high sensitivity and resolution has been developed based on biocompatible paramagnetic ultrasmall NaGdF4 nanoprobes. Owing to the appropriate hydrodynamic diameter, the nanoprobe can be confined inside the blood vessels and it only extravasates at the vascular injury site when the bleeding occurs. Relying on this property, the three-dimensional (3D) anatomic structures of artery occlusion of stroke rat can be precisely visualized; reperfusion-related SAH has been successfully visualized and identified. Benefiting from the long blood half-life of the nanoprobe, the observation window of MR angiography can last for the whole period of reperfusion, thereby monitoring the probable SAH in real time during thrombolytic therapy. More importantly, through reconstruction of multiparametric MRI, the arterial occlusion, cerebral ischemic region, and SAH can be simultaneously visualized in vivo in a 3D manner for the first time. Therefore, the current study provides a novel approach for both noninvasive 3D vascular visualization and hemorrhage alert, which possesses great prospects for clinical translation.
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Affiliation(s)
- Peisen Zhang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Junwei Cheng
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Chuang Liu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Wenyue Li
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Yuqing Wang
- Tsinghua Laboratory of Brain and Intelligence, Tsinghua University, Beijing 100084, China
| | - Ni Zhang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jin Wu
- Physical Examination Center, The Second Department of Health and Medical Care, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xinyu Zhang
- Physical Examination Center, The Second Department of Health and Medical Care, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyong Liu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Yi Hou
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
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Liu CD, Peng Q, Wang SY, Deng Y, Li ZY, Xu ZH, Wu L, Zhang YD, Duan R. Circ_0008146 Exacerbates Ferroptosis via Regulating the miR-342-5p/ACSL4 Axis After Cerebral Ischemic/Reperfusion. J Inflamm Res 2024; 17:4957-4973. [PMID: 39077373 PMCID: PMC11284150 DOI: 10.2147/jir.s464655] [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: 05/27/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose Acute ischemic stroke (AIS) has seriously threatened people's health worldwide and there is an urge need for early diagnosis and effective treatment of AIS. This research intended to clarify the regulatory role of circ_0008146/miR-342-5p/ACSL4 axis in AIS. Methods High-throughput small RNA sequencing analysis was adapted to identify differentially expressed miRNAs between the AIS and control group. The circ_0008146, miR-342-5p, and ACSL4 levels were detected by qRT-PCR. Middle cerebral artery occlusion/reperfusion (MCAO/R) models were constructed in C57BL/6J mice. Assay kits were used to determine Fe2+ levels and a battery of oxidative stress and lipid peroxidation indicators, including ROS, MDA, LPO, SOD and GSH/GSSG ratio. The protein levels of ACSL4 were measured by Western blot. The behavioral function was assessed using neurobehavioral tests. TTC staining was employed to visualize infarction size. Nissl staining was adapted to detect histopathological changes. Receiver operating characteristic curve and correlation analysis were applied to investigate the clinical value and association of miR-342-5p and ACSL4. Results A total of 44 AIS patients and 49 healthy controls were enrolled in our study. The small RNA sequencing unveiled a significant decrease in miR-342-5p levels in AIS patients. MiR-342-5p inhibited oxidative stress and RSL3-induced ferroptosis after cerebral ischemic/reperfusion injury in vivo by targeting ferroptosis-related gene ACSL4. Circ_0008146 acted as a sponge of miR-342-5p, and overexpression of circ_0008146 increased neurological deficits and brain injury in mice. Circ_0008146 contributed to ferroptosis in cerebral infarction via sponging miR-342-5p to regulate ACSL4. Plasma miR-342-5p and ACSL4 demonstrated significant correlation and good diagnostic value for AIS patients. Conclusion This study provides the first in vivo evidence to show that circ_0008146 exacerbates neuronal ferroptosis after AIS via the miR-342-5p/ACSL4 axis. Furthermore, miR-342-5p/ACSL4 axis holds promise as a viable therapeutic target and practical biomarkers for AIS patients.
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Affiliation(s)
- Cai-Dong Liu
- Department of Laboratory Medicine, Nanjing First Hospital, China Pharmaceutical University, Nanjing, Jiangsu, 210006, People’s Republic of China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Qiang Peng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Shi-Yao Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Yang Deng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Zhong-Yuan Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Zhao-Han Xu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Liang Wu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Ying-Dong Zhang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, 210006, People’s Republic of China
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
| | - Rui Duan
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People’s Republic of China
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Wang K, Yang L, Li Q, Yang X, Chen Z, Zhou Y, Jia Y, Gong Z. Long-Term Alcohol Exposure Aggravates Ischemic Stroke-Induced Damage by Promoting Pericyte NLRP3 Inflammasome Activation via Pre-Activating the TLR4/NF-κB Pathway in Rats. J Inflamm Res 2024; 17:4791-4810. [PMID: 39051052 PMCID: PMC11268848 DOI: 10.2147/jir.s465780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background Ischemic stroke (IS) is one of the leading causes of death and disability in the world, and alcohol consumption has been gaining attention as an independent risk factor for IS. Blood-brain barrier (BBB) dysfunction and neuroinflammation are the core of cerebral ischemia/reperfusion (I/R) injury, and pericytes play a crucial role in the structure and function. This study is to explore the effects of long-term alcohol consumption on IS and the potential mechanisms of pericytes. Methods Rat models of long-term alcohol intake followed by transient middle cerebral artery occlusion stroke (EtOH+tMCAO) and cell models of oxygen-glucose deprivation/reoxygenation (OGD/R) with alcohol pre-treatment were constructed. Results Worsened infarct volume, neurological scores, and BBB disruption were observed in the EtOH+tMCAO group compared with the tMCAO group, and immunofluorescence staining showed increased pericytes NLPR3 inflammasome activation at the ischemic penumbra. In vitro, pericyte mortality and LDH release elevated pre-treated by alcohol after OGD/R, and amplified expression of NLRP3 inflammasome was detected by Western blotting and qPCR. Alcohol pre-treatment activated the TLR4/NF-κB pathway, and transfecting pericytes with TLR4-small interfering RNA (siRNA) to block TLR4 signaling markedly restrained NLRP3 inflammasome over-activation. Injecting TAK-242 in rats alleviated neurological impairment caused by alcohol. Conclusion Long-term alcohol pre-treatment aggravated ischemic stroke-induced brain damage by activating NLRP3 inflammasome via TLR4/NF-κB signaling pathway in the pericytes.
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Affiliation(s)
- Kaixin Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Lingfei Yang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Qingsheng Li
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Xuan Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Ziyi Chen
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yongyan Zhou
- Department of Electrocardiogram, Zhoukou Center Hospital, Zhoukou, People’s Republic of China
| | - Yanjie Jia
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zhe Gong
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Zhang Y, Lu H, Ren X, Zhang J, Wang Y, Zhang C, Zhao X. Immediate and long-term brain activation of acupuncture on ischemic stroke patients: an ALE meta-analysis of fMRI studies. Front Neurosci 2024; 18:1392002. [PMID: 39099634 PMCID: PMC11294246 DOI: 10.3389/fnins.2024.1392002] [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: 04/23/2024] [Accepted: 07/11/2024] [Indexed: 08/06/2024] Open
Abstract
Background Acupuncture, as an alternative and complementary therapy recommended by the World Health Organization for stroke treatment, holds potential in ameliorating neurofunctional deficits induced by ischemic stroke (IS). Understanding the immediate and long-term effects of acupuncture and their interrelation would contribute to a better comprehension of the mechanisms underlying acupuncture efficacy. Methods Activation likelihood estimation (ALE) meta-analysis was used to analyze the brain activation patterns reported in 21 relevant functional neuroimaging studies. Among these studies, 12 focused on the immediate brain activation and 9 on the long-term activation. Single dataset analysis were employed to identify both immediate and long-term brain activation of acupuncture treatment in IS patients, while contrast and conjunction analysis were utilized to explore distinctions and connections between the two. Results According to the ALE analysis, immediately after acupuncture treatment, IS patients exhibited an enhanced cluster centered around the right precuneus (PCUN) and a reduced cluster centered on the left middle frontal gyrus (MFG). After long-term acupuncture treatment, IS patients showed an enhanced cluster in the left PCUN, along with two reduced clusters in the right insula (INS) and hippocampus (HIP), respectively. Additionally, in comparison to long-term acupuncture treatment, the right angular gyrus (ANG) demonstrated higher ALE scores immediately after acupuncture, whereas long-term acupuncture resulted in higher scores in the left superior parietal gyrus (SPG). The intersecting cluster activated by both of them was located in the left cuneus (CUN). Conclusion The findings provide initial insights into both the immediate and long-term brain activation patterns of acupuncture treatment for IS, as well as the intricate interplay between them. Both immediate and long-term acupuncture treatments showed distinct patterns of brain activation, with the left CUN emerging as a crucial regulatory region in their association. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, CRD42023480834.
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Affiliation(s)
- Yuan Zhang
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hai Lu
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xuesong Ren
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Junfeng Zhang
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yu Wang
- Department of Rehabilitation, Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunhong Zhang
- Department of Acupuncture and Moxibustion, Baoan Pure Traditional Chinese Medicine Treatment Hospital, Shenzhen, China
| | - Xiaofeng Zhao
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Zhu L, Zhong W, Meng X, Yang X, Zhang W, Tian Y, Li Y. Polymeric nanocarriers delivery systems in ischemic stroke for targeted therapeutic strategies. J Nanobiotechnology 2024; 22:424. [PMID: 39026255 PMCID: PMC11256638 DOI: 10.1186/s12951-024-02673-4] [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: 01/15/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Ischemic stroke is a complex, high-mortality disease with multifactorial etiology and pathogenesis. Currently, drug therapy is mainly used treat ischemic stroke in clinic, but there are still some limitations, such as limited blood-brain barrier (BBB) penetration efficiency, a narrow treatment time window and drug side effects. Recent studies have pointed out that drug delivery systems based on polymeric nanocarriers can effectively improve the insufficient treatment for ischemic stroke. They can provide neuronal protection by extending the plasma half-life of drugs, enhancing the drug's permeability to penetrate the BBB, and targeting specific structures and cells. In this review, we classified polymeric nanocarriers used for delivering ischemic stroke drugs and introduced their preparation methods. We also evaluated the feasibility and effectiveness and discussed the existing limitations and prospects of polymeric nanocarriers for ischemic stroke treatment. We hoped that this review could provide a theoretical basis for the future development of nanomedicine delivery systems for the treatment of ischemic stroke.
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Affiliation(s)
- Lin Zhu
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Weijie Zhong
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Xuchen Meng
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Xiaosheng Yang
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Wenchuan Zhang
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Yayuan Tian
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
| | - Yi Li
- Department of Neurosurgery, Ninth People Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
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Ma L, Sun F, Zhu K, Han Q, Sun Q. The Predictive Value of Atherogenic Index of Plasma, Non- High Density Lipoprotein Cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and Lipoprotein Combine Index for Stroke Incidence and Prognosis in Maintenance Hemodialysis Patients. Clin Interv Aging 2024; 19:1235-1245. [PMID: 38978964 PMCID: PMC11230120 DOI: 10.2147/cia.s461150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose The serum lipid level is strongly associated with atherosclerosis. However, research on the relationship between lipid-derived indices and acute ischemic stroke (AIS) occurrence in hemodialysis populations is limited. This study aimed to explore the predictive value of lipid-derived indices, including atherogenic index of plasma (AIP), Non- high density lipoprotein cholesterol (Non-HDL-C), Non-HDL-C/HDL-C, and lipoprotein combine index (LCI) in clinical practice for the occurrence and prognosis of AIS in hemodialysis patients. Methods A total of 451 patients undergoing maintenance hemodialysis were screened and 350 were enrolled in this study. The lipid parameters exhibit a progressive increase across the tertiles, with values rising from Q1 through Q3. Enrolled patients were divided into three groups (Q1, Q2, and Q3) based on tertiles of AIP, Non-HDL-C, Non-HDL-C/HDL-C, and LCI values. Kaplan-Meier curves were performed to investigate the association between the AIP, Non-HDL-C, Non-HDL-C/HDL-C, LCI and AIS-free survival in hemodialysis patients. Chi-square analysis was used to explore the association between the AIP, Non-HDL-C, Non-HDL-C/HDL-C, LCI and AIS outcomes in hemodialysis patients. AIS outcomes were assessed using the modified Rankin Scale (mRS). Results Kaplan-Meier analysis revealed that the AIS-free survival rates were significantly higher in the Q1 group compared to Q2 and Q3 groups for AIP, Non-HDL-C, Non-HDL-C/HDL-C, and LCI. Log rank tests showed statistically significant differences between the Q1 group and the Q2 and Q3 groups (p < 0.05 for all). The proportion of patients with a good outcome mRS was higher in the Q1 group compared to the Q2-Q3 groups (AIP: 0.818 vs 0.792; Non- HDL-C: 0.866 vs 0.767; Non- HDL-C/HDL-C: 0.867 vs 0.767; LCI: 0.938 vs 0.750). Conclusion The four lipid-derived parameters are effective predictors of AIS in patients undergoing hemodialysis, and AIP has a strongest correlation with the risk of AIS. Hemodialysis patients with elevated levels of the four lipid-derived indices had a higher incidence of AIS and poorer functional outcomes compared to those with lower levels. Our conclusions may require confirmation by further research in the future.
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Affiliation(s)
- Lijie Ma
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Fang Sun
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Kaiyi Zhu
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qiuxia Han
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qianmei Sun
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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Wang R, Mao L, Liang P, Gan Y, Gao Q, Liang S, Zhang D, Luo G, Yang S. Combining metabolomics and network pharmacology to investigate the protective effect of Jiawei Xinglou Chengqi Granules in ischemic stroke. Braz J Med Biol Res 2024; 57:e13388. [PMID: 38958365 PMCID: PMC11221863 DOI: 10.1590/1414-431x2024e13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/17/2024] [Indexed: 07/04/2024] Open
Abstract
Jiawei Xinglou Chengqi Granule (JXCG) is an effective herbal medicine for the treatment of ischemic stroke (IS). JXCG has been shown to effectively ameliorate cerebral ischemic symptoms in clinical practice, but the underlying mechanisms are unclear. In this study, we investigated the mechanisms of action of JXCG in the treatment of IS by combining metabolomics with network pharmacology. The chemical composition of JXCG was analyzed using ultra-high performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS). Ultra-high performance liquid chromatography-tandem time-of-flight mass spectrometry (UHPLC-Q-TOF MS) untargeted metabolomics were used to identify differential metabolites within metabolic pathways. Network pharmacology was applied to mine potential targets of JXCG in the treatment of IS. The identified key targets were validated by constructing an integrated network of metabolomics and network pharmacology and by molecular docking using Cytoscape. The effect of JXCG on IS was evaluated in vivo, and the predicted targets and pathways of JXCG in IS therapy were assessed using immunoblotting. Combining metabolomics and network pharmacology, we identified the therapeutic targets of JXCG for IS. Notably, JXCG lessened neuronal damage and reduced cerebral infarct size in rats with IS. Western blot analysis showed that JXCG upregulated PRKCH and downregulated PRKCE and PRKCQ proteins. Our combined network pharmacology and metabolomics findings showed that JXCG may have therapeutic potential in the treatment of IS by targeting multiple factors and pathways.
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Affiliation(s)
- Raoqiong Wang
- National Traditional Chinese Medicine Clinical Research Base, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Linshen Mao
- National Traditional Chinese Medicine Clinical Research Base, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Pan Liang
- National Traditional Chinese Medicine Clinical Research Base, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Yulu Gan
- Southwest Medical University, Luzhou, China
| | - Qixue Gao
- Southwest Medical University, Luzhou, China
| | | | - Dechou Zhang
- National Traditional Chinese Medicine Clinical Research Base, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Gang Luo
- National Traditional Chinese Medicine Clinical Research Base, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Sijin Yang
- National Traditional Chinese Medicine Clinical Research Base, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, China
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Wang Y, Shan T, Mao P, Jiang Y, Wang Z. FOXP3 gene is associated with susceptibility to ischemic stroke in the Chinese population. Clin Neurol Neurosurg 2024; 242:108313. [PMID: 38754303 DOI: 10.1016/j.clineuro.2024.108313] [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: 03/07/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
AIM Immunoinflammatory response plays an important role in the pathophysiological process of ischemic stroke (IS). Forkhead box P3 (FOXP3) is a master regulator for immune cells. Polymorphisms of FOXP3 gene might contribute to the susceptibility of IS. This study aimed to explore the association between FOXP3 gene polymorphisms (rs3761548 and rs2232365) and IS susceptibility in the Chinese Han population. METHODS Polymerase chain reaction and Sanger sequencing were used to detect the genotype of FOXP3 gene rs3761548 and rs2232365 polymorphisms. RESULTS Smoking, diabetes mellitus (DM), and HBP histories, higher TG and HDL-C levels were more frequently observed in IS patients than in controls. In comparison with rs3761548 GG genotype, GT genotype (OR = 1.573, 95 %CI = 1.030-2.402; adjusted: OR = 1.736, 95 %CI = 1.070-2.817) and GT + TT vs. GG model (OR = 1.581, 95 %CI = 1.0449-2.382; adjusted: OR = 1.720, 95 %CI = 1.074-2.755) of rs3761548 polymorphism was significantly correlated with elevated ischemic stroke susceptibility both at prior and after adjusted by smoking, HBP, DM, TG and HDL-C. Recessive model of rs2232365 polymorphism could elevate the susceptibility of ischemic stroke (OR = 11.962, 95 %CI = 1.144-3.3363; adjusted: OR = 1.876, 95 %CI = 1.016-3.463). Besides, rs3761548 dominant model (OR = 2.757, 95 %CI = 1.379-5.552; adjusted: OR = 2.601, 95 %CI = 1.268-5.336) and rs2232365 recessive model (OR = 3.103, 95 %CI = 1.463-6.583; adjusted: OR = 3.545, 95 %CI = 1.600-7.855) were related to the severity of ischemic stroke. CONCLUSION FOXP3 gene rs3761548 and rs2232365 polymorphisms were risk factors for susceptibility and severity of IS.
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Affiliation(s)
- Youpei Wang
- Department of Geriatric Medicine, Qingdao Chengyang People's Hospital, Qingdao 266109, China
| | - Tiru Shan
- Department of Geriatric Medicine, Qingdao Chengyang People's Hospital, Qingdao 266109, China
| | - Peipei Mao
- Department of Geriatric Medicine, Qingdao Chengyang People's Hospital, Qingdao 266109, China
| | - Yi Jiang
- Department of Neurology II, Qingdao Chengyang People's Hospital, Qingdao 266109, China
| | - Zhao Wang
- Health Management Center, Qingdao Chengyang People's Hospital, Qingdao 266109, China.
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40
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Jiang M, Li G, He Q, Zhang Y, Li W, Gao Y, Yan J. Multimodal imaging evaluation of early neurological deterioration following acute ischemic stroke. Quant Imaging Med Surg 2024; 14:4763-4778. [PMID: 39022232 PMCID: PMC11250343 DOI: 10.21037/qims-24-153] [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: 01/26/2024] [Accepted: 06/05/2024] [Indexed: 07/20/2024]
Abstract
Background Early neurologic deterioration occurs in up to one-third of patients with acute ischemic stroke (IS), often leading to poor functional outcomes. At present, few studies have applied amide proton transfer (APT) imaging to the evaluation of early neurological deterioration (END). This study analyzed the value of computed tomography perfusion (CTP) combined with multimodal magnetic resonance imaging (MRI) in patients with acute IS with END. Methods This retrospective study included patients with acute IS who were admitted to the neurology inpatient department in a tertiary hospital from October 2021 to June 2023. Patients with acute IS underwent CTP within 24 hours of stroke onset and MRI [arterial spin labeling (ASL), susceptibility-weighted imaging (SWI), and APT] within 7 days. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 7 days of stroke onset. Univariable and multivariable analyses were used to compare clinical and imaging biomarkers in patients with acute IS with and without END. The performance of potential biomarkers in distinguishing between the two groups was evaluated using receiver operating characteristic (ROC) curve analysis. Results Among the 70 patients with acute IS, 20 (29%) had END. After conducting univariable analysis, variables were selected for entry into a binary logistic regression analysis based on our univariable analysis results, previous research findings, clinical experience, and methodological standards. The results indicated that relative cerebral blood volume (CBV) on CTP, relative cerebral blood flow (CBF) on ASL, and relative signal intensity on amide proton transfer-weighted (APTw) imaging were independent risk factors for END. The areas under the ROC curves for these risk factors were 0.710 [95% confidence interval (CI): 0.559-0.861, P=0.006], 0.839 (95% CI: 0.744-0.933, P<0.001), and 0.804 (95% CI: 0.676-0.932, P<0.001), respectively. The combined area under the curve (AUC), sensitivity, and specificity of the four indices (0.941, 100%, and 78%, respectively) were higher than those of the four indices alone. Conclusions CTP combined with multi-modal MRI better evaluated hemodynamics, tissue metabolism, and other relevant patient information, providing an objective basis for the clinical assessment of patients with acute IS with END and facilitating the development of accurate and personalized treatment plans.
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Affiliation(s)
- Meien Jiang
- Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guomin Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qinmeng He
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yulin Zhang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wuming Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yunyu Gao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Jianhao Yan
- Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
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Güp AA, Bayar B. Immediate effects of trunk Kinesio Taping® on functional parameters in the acute stage of patients with mild stroke: A randomized controlled trial. Physiother Theory Pract 2024; 40:1447-1458. [PMID: 37083470 DOI: 10.1080/09593985.2023.2204353] [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: 12/08/2022] [Accepted: 03/15/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Improving early trunk control, balance, and sitting activity following acute stroke is critical for functional prognosis. PURPOSE To compare the immediate efficacy of Kinesio Taping® (KT) application on anterior and posterior trunk muscles in terms of improving trunk control, balance, and sit-to-stand performance in the acute stage of stroke. METHODS Sixty-nine patients with acute mild stroke were allocated to the anterior KT group (AKT) (age = 65.95 ± 9.67; 12 females, 11 males; Modified Rankin Score = 3), posterior KT group (PKT) (age = 65.39 ± 10.39; 10 females, 13 males; Modified Rankin Score = 3), and control group (CG) (age = 65.34 ± 8.91; 11 females, 12 males; Modified Rankin Score = 2). Trunk control, balance, and sit-to-stand performance were assessed at the baseline and after 45 minutes and 48 hours post-KT. Data were analyzed using repeated-measures ANOVA. RESULTS All outcome measures scores improved in all groups significantly after 48 hours (p < .001). A significant improvement after 45 minutes was only seen in trunk control compared to the CG (p < .001; d = 1.32 for AKT and p = .038; d = 0.75 for PKT). Trunk control, balance, and sit-to-stand performance improved in both AKT and PKT compared to the CG at 48 hours post-taping. Trunk control (p < .001; d = 0.26) and balance (p < .001; d = 0.72) results were in favor of the AKT, while sit-to-stand performance results did not make a difference between KT groups (p = .335; d = 0.47). CONCLUSION KT application on anterior or posterior trunk muscles was effective for improving trunk control, balance, and sit-to-stand performance in acute stage of stroke in the short term. KT application on anterior trunk muscles had the advantage of improving trunk control and balance.
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Affiliation(s)
- Asalet Aybüke Güp
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Banu Bayar
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
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Mirza AA, Saad MZ, Bittla P, Paidimarri SP, Ayuthu S, Chauhan YD, Khan S. A Detailed Systematic Review Comparing Patent Foramen Ovale Closure vs Medical Therapy for the Prevention of Recurrent Cryptogenic Stroke. Cureus 2024; 16:e65632. [PMID: 39205754 PMCID: PMC11357720 DOI: 10.7759/cureus.65632] [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: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Cryptogenic stroke refers to a type of ischemic stroke with no identifiable cause despite extensive diagnostic testing. Patent foramen ovale (PFO) treatment modality for the prevention of cryptogenic stroke has been controversial. We undertook this systematic review to compare the efficacy of PFO closure versus medical therapy in preventing recurrent cryptogenic stroke and to provide insight into the most effective treatment modality. Inclusion criteria included patients who had PFO, papers written in English language or had translation available, and papers focusing on medical therapy including drug and surgical treatment for PFO for the prevention of recurrent stroke. Exclusion criteria included articles in which full text could not be obtained and articles in which only one treatment modality was mentioned, either surgical closure or drug therapy. The databases used were PubMed, Cochrane, Embase, and ClinicalTrials.gov. We conducted a bias assessment through the modified Jadad scale for randomized controlled trials (RCTs) and AMSTAR.Ca for meta-analysis and systematic review. The literature search identified a total of 277 papers. After screening, 12 papers were selected for the review. Among these, five were RCTs, five were meta-analyses, one was a systematic review, and one was a systematic review with network meta-analysis. The RCTs included a total of 3,336 participants, while the meta-analyses included 21,813 participants. These finalized papers examined the outcomes of PFO closure compared to medical therapy in preventing recurrent strokes.
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Affiliation(s)
- Amna A Mirza
- Medicine, Ziauddin Medical College, Karachi, PAK
| | - Moyal Z Saad
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | | | | | - Shriya Ayuthu
- Medicine, Kamineni Institute of Medical Sciences, Nalgonda, IND
| | - Yashkumar D Chauhan
- Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, USA
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Lee HJ, Shin HK, Kim JH, Choi BT. Transcriptome Analysis of the Striatum of Electroacupuncture-treated Naïve and Ischemic Stroke Mice. J Pharmacopuncture 2024; 27:162-171. [PMID: 38948311 PMCID: PMC11194526 DOI: 10.3831/kpi.2024.27.2.162] [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: 04/26/2024] [Revised: 05/09/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
Objectives Electroacupuncture (EA) has been demonstrated to aid stroke recovery. However, few investigations have focused on identifying the potent molecular targets of EA by comparing EA stimulation between naïve and disease models. Therefore, this study was undertaken to identify the potent molecular therapeutic mechanisms underlying EA stimulation in ischemic stroke through a comparison of mRNA sequencing data obtained from EA-treated naïve control and ischemic stroke mouse models. Methods Using both naïve control and middle cerebral artery occlusion (MCAO) mouse models, EA stimulation was administered at two acupoints, Baihui (GV20) and Dazhui (GV14), at a frequency of 2 Hz. Comprehensive assessments were conducted, including behavioral evaluations, RNA sequencing to identify differentially expressed genes (DEGs), functional enrichment analysis, protein-protein interaction (PPI) network analysis, and quantitative real-time PCR. Results EA stimulation ameliorated the ischemic insult-induced motor dysfunction in mice with ischemic stroke. Comparative analysis between control vs. MCAO, control vs. control + EA, and MCAO vs. MCAO + EA revealed 4,407, 101, and 82 DEGs, respectively. Of these, 30, 7, and 1 were common across the respective groups. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed upregulated DEGs associated with the regulation of inflammatory immune response in the MCAO vs. MCAO + EA comparison. Conversely, downregulated DEGs in the control vs. control + EA comparison were linked to neuronal development. PPI analysis revealed major clustering related to the regulation of cytokines, such as Cxcl9, Pcp2, Ccl11, and Cxcl13, in the common DEGs of MCAO vs. MCAO + EA, with Esp8l1 identified as the only common downregulated DEG in both EA-treated naïve and ischemic models. Conclusion These findings underscore the diverse potent mechanisms of EA stimulation between naïve and ischemic stroke mice, albeit with few overlaps. However, the potent mechanisms underlying EA treatment in ischemic stroke models were associated with the regulation of inflammatory processes involving cytokines.
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Affiliation(s)
- Hong Ju Lee
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Hwa Kyoung Shin
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Ji-Hwan Kim
- Department of Sasang Constitutional Medicine, Division of Clinical Medicine 4, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Byung Tae Choi
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
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Wang LR, Li BH, Zhang Q, Cheng XD, Jia LJ, Zhou S, Yang S, Wang JH, Yu NW. Predictors of futile recanalization after endovascular treatment of acute ischemic stroke. BMC Neurol 2024; 24:207. [PMID: 38886670 PMCID: PMC11181662 DOI: 10.1186/s12883-024-03719-8] [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: 11/02/2023] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Endovascular therapy (EVT) is the most successful treatment for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. However, futile recanalization (FR) seriously affects the prognosis of these patients. The aim of this study was to investigate predictors of FR after EVT in patients with AIS. METHOD Patients diagnosed with AIS due to anterior circulation LVO and receiving EVT between June 2020 and October 2022 were prospectively enrolled. FR after EVT was defined as a poor 90-day prognosis (modified Rankin Scale [mRS] score ≥ 3) despite achieving successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] classification of 2b-3). All included patients were categorized into control group (mRS score < 3) and FR group (mRS score ≥ 3). Demographic characteristics, comorbidities (hypertension, diabetes, atrial fibrillation, smoking, etc.), stroke-specific data (NIHSS score, ASPECT score and site of occlusion), procedure data (treatment type [direct thrombectomy vs. bridging thrombectomy], degree of vascular recanalization [mTICI], procedure duration time and onset-recanalization time), laboratory indicators (lymphocytes count, neutrophils count, monocytes count, C-reactive protein, neutrophil-to-lymphocyte ratio [NLR], monocyte-to-high-density lipoprotein ratio [MHR], lymphocyte-to-monocyte ratio [LMR], lymphocyte-to-C-reactive protein ratio [LCR], lymphocyte-to-high-density lipoprotein ratio[LHR], total cholesterol and triglycerides.) were compared between the two groups. Multivariate logistic regression analysis was performed to explore independent predictors of FR after EVT. RESULTS A total of 196 patients were included in this study, among which 57 patients were included in the control group and 139 patients were included in the FR group. Age, proportion of patients with hypertension and diabetes mellitus, median NIHSS score, CRP level, procedure duration time, neutrophil count and NLR were higher in the FR group than in the control group. Lymphocyte count, LMR, and LCR were lower in the FR group than in the control group. There were no significant differences in platelet count, monocytes count, total cholesterol, triglycerides, HDL, LDL, gender, smoking, atrial fibrillation, percentage of occluded sites, onset-recanalization time, ASPECT score and type of treatment between the two groups. Multivariate logistic regression analysis demonstrated that NLR was independently associated with FR after EVT (OR = 1.37, 95%CI = 1.005-1.86, P = 0.046). CONCLUSION This study demonstrated that high NLR was associated with a risk of FR in patients with AIS due to anterior circulation LVO. These findings may help clinicians determine which patients with AIS are at higher risk of FR after EVT. Our study can provide a theoretical basis for interventions in the aforementioned population.
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Affiliation(s)
- Li-Rong Wang
- University of Electronic Science and Technology of China, Chengdu, 610054, China
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Bing-Hu Li
- University of Electronic Science and Technology of China, Chengdu, 610054, China.
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Qi Zhang
- University of Electronic Science and Technology of China, Chengdu, 610054, China
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Xu-Dong Cheng
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Li-Jun Jia
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Sen Zhou
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Shu Yang
- University of Electronic Science and Technology of China, Chengdu, 610054, China
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Jian-Hong Wang
- University of Electronic Science and Technology of China, Chengdu, 610054, China
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Neng-Wei Yu
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, 610072, China.
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Pinontoan R, Purnomo JS, Avissa EB, Tanojo JP, Djuan M, Vidian V, Samantha A, Jo J, Steven E. In-vitro and in-silico analyses of the thrombolytic potential of green kiwifruit. Sci Rep 2024; 14:13799. [PMID: 38877048 PMCID: PMC11178772 DOI: 10.1038/s41598-024-64160-y] [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: 11/03/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
Cardiovascular diseases (CVDs), mainly caused by thrombosis complications, are the leading cause of mortality worldwide, making the development of alternative treatments highly desirable. In this study, the thrombolytic potential of green kiwifruit (Actinidia deliciosa cultivar Hayward) was assessed using in-vitro and in-silico approaches. The crude green kiwifruit extract demonstrated the ability to reduce blood clots significantly by 73.0 ± 1.12% (P < 0.01) within 6 h, with rapid degradation of Aα and Bβ fibrin chains followed by the γ chain in fibrinolytic assays. Molecular docking revealed six favorable conformations for the kiwifruit enzyme actinidin (ADHact) and fibrin chains, supported by spontaneous binding energies and distances. Moreover, molecular dynamics simulation confirmed the binding stability of the complexes of these conformations, as indicated by the stable binding affinity, high number of hydrogen bonds, and consistent distances between the catalytic residue Cys25 of ADHact and the peptide bond. The better overall binding affinity of ADHact to fibrin chains Aα and Bβ may contribute to their faster degradation, supporting the fibrinolytic results. In conclusion, this study demonstrated the thrombolytic potential of the green kiwifruit-derived enzyme and highlighted its potential role as a natural plant-based prophylactic and therapeutic agent for CVDs.
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Affiliation(s)
- Reinhard Pinontoan
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia.
| | | | - Elvina Bella Avissa
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Jessica Pricilla Tanojo
- Center of Excellence Applied Science Academy, Sekolah Pelita Harapan Lippo Village, Tangerang, 15810, Indonesia
| | - Moses Djuan
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Valerie Vidian
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Ariela Samantha
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
| | - Juandy Jo
- Department of Biology, Universitas Pelita Harapan, Tangerang, 15811, Indonesia
- Mochtar Riady Institute for Nanotechnology, Lippo Karawaci, Tangerang, 15810, Indonesia
| | - Eden Steven
- Center of Excellence Applied Science Academy, Sekolah Pelita Harapan Lippo Village, Tangerang, 15810, Indonesia
- Emmerich Research Center, Jakarta, 14450, Indonesia
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Xie L, He M, Ying C, Chu H. Mechanisms of inflammation after ischemic stroke in brain-peripheral crosstalk. Front Mol Neurosci 2024; 17:1400808. [PMID: 38932932 PMCID: PMC11199882 DOI: 10.3389/fnmol.2024.1400808] [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: 03/14/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Stroke is a devastating disease with high morbidity, disability, and mortality, among which ischemic stroke is more common. However, there is still a lack of effective methods to improve the prognosis and reduce the incidence of its complications. At present, there is evidence that peripheral organs are involved in the inflammatory response after stroke. Moreover, the interaction between central and peripheral inflammation includes the activation of resident and peripheral immune cells, as well as the activation of inflammation-related signaling pathways, which all play an important role in the pathophysiology of stroke. In this review, we discuss the mechanisms of inflammatory response after ischemic stroke, as well as the interactions through circulatory pathways between peripheral organs (such as the gut, heart, lung and spleen) and the brain to mediate and regulate inflammation after ischemic stroke. We also propose the potential role of meningeal lymphatic vessels (MLVs)-cervical lymph nodes (CLNs) as a brain-peripheral crosstalk lymphatic pathway in ischemic stroke. In addition, we also summarize the mechanisms of anti-inflammatory drugs in the treatment of ischemic stroke.
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Affiliation(s)
- Ling Xie
- Department of Critical Medicine, First People's Hospital of Linping District, Hangzhou, China
| | - Ming He
- Department of Critical Medicine, First People's Hospital of Linping District, Hangzhou, China
| | - Caidi Ying
- Department of Hepatobiliary and Pancreatic Surgery, The Traditional Chinese Medicine Hospital of Ningbo, Ningbo, China
| | - Haifeng Chu
- Department of Neurosurgery, The Traditional Chinese Medicine Hospital of Linping District, Hangzhou, China
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Li Y, Li N, Zhou Y, Li L. Predicting ineffective thrombolysis in acute ischemic stroke with clinical and biochemical markers. Sci Rep 2024; 14:13424. [PMID: 38862629 PMCID: PMC11166982 DOI: 10.1038/s41598-024-64413-w] [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: 03/28/2024] [Accepted: 06/08/2024] [Indexed: 06/13/2024] Open
Abstract
**Ischemic stroke remains a leading cause of morbidity and mortality globally. Despite the advances in thrombolytic therapy, notably recombinant tissue plasminogen activator (rtPA), patient outcomes are highly variable. This study aims to introduce a novel predictive model, the Acute Stroke Thrombolysis Non-Responder Prediction Model (ASTN-RPM), to identify patients unlikely to benefit from rtPA within the critical early recovery window. We conducted a retrospective cohort study at Baoding No.1 Central Hospital including 709 adult patients diagnosed with acute ischemic stroke and treated with intravenous alteplase within the therapeutic time window. The ASTN-RPM was developed using Least Absolute Shrinkage and Selection Operator (LASSO) regression technique, incorporating a wide range of biomarkers and clinical parameters. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and Decision Curve Analysis (DCA). ASTN-RPM effectively identified patients at high risk of poor response to thrombolysis, with an AUC of 0.909 in the training set and 0.872 in the validation set, indicating high sensitivity and specificity. Key predictors included posterior circulation stroke, high admission NIHSS scores, extended door to needle time, and certain laboratory parameters like homocysteine levels. The ASTN-RPM stands as a potential tool for refining clinical decision-making in ischemic stroke management. By anticipating thrombolytic non-response, clinicians can personalize treatment strategies, possibly improving patient outcomes and reducing the burden of ineffective interventions. Future studies are needed for external validation and to explore the incorporation of emerging biomarkers and imaging data.
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Affiliation(s)
- Yinglei Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Emergency Medicine, Baoding No.1 Central Hospital, Baoding, China
| | - Ning Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuanyuan Zhou
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Litao Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China.
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China.
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Hebei General Hospital, Shijiazhuang, China.
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Shuai H, Wang Z, Xiao Y, Ge Y, Mao H, Gao J. Genetically supported causality between gut microbiota, immune cells, and ischemic stroke: a two-sample Mendelian randomization study. Front Microbiol 2024; 15:1402718. [PMID: 38894965 PMCID: PMC11185428 DOI: 10.3389/fmicb.2024.1402718] [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: 03/18/2024] [Accepted: 05/06/2024] [Indexed: 06/21/2024] Open
Abstract
Background Previous studies have highlighted a robust correlation between gut microbiota/immune cells and ischemic stroke (IS). However, the precise nature of their causal relationship remains uncertain. To address this gap, our study aims to meticulously investigate the causal association between gut microbiota/immune cells and the likelihood of developing IS, employing a two-sample Mendelian randomization (MR) analysis. Methods Our comprehensive analysis utilized summary statistics from genome-wide association studies (GWAS) on gut microbiota, immune cells, and IS. The primary MR method employed was the inverse variance-weighted (IVW) approach. To address potential pleiotropy and identify outlier genetic variants, we incorporated the Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) technique, along with MR-Egger regression. Heterogeneity was assessed using Cochran's Q-test. Additionally, leave-one-out analysis was conducted to pinpoint any individual genetic variant influencing the observed causal associations. Finally, a reverse MR analysis was performed to explore the potential of reverse causation. Results Our investigation revealed four gut microbial taxa and 16 immune cells with a significant causal relationship with IS (p < 0.05). Notably, two bacterial features and five immunophenotypes were strongly associated with a lower IS risk: genus.Barnesiella.id.944 (OR: 0.907, 95% CI: 0.836-0.983, p = 0.018), genus.LachnospiraceaeNK4A136group.id.11319 (OR: 0.918, 95% CI: 0.853-0.983, p = 0.988), Activated & resting Treg % CD4++ (OR: 0.977, 95% CI: 0.956-0.998, p = 0.028). Additionally, significant associations between IS risk and two bacterial features along with eleven immunophenotypes were observed: genus.Paraprevotella.id.962 (OR: 1.106, 95% CI: 1.043-1.172, p < 0.001), genus.Streptococcus.id.1853 (OR: 1.119, 95% CI: 1.034-1.210, p = 0.005), CD127 on granulocyte (OR: 1.039, 95% CI: 1.009-1.070, p = 0.011). Our analyses did not reveal heterogeneity based on the Cochrane's Q-test (p > 0.05) nor indicate instances of horizontal pleiotropy according to MR-Egger and MR-PRESSO analyses (p > 0.05). Furthermore, the robustness of our MR results was confirmed through leave-one-out analysis. Conclusion Our study provides further evidence supporting the potential association between gut microbiota and immune cells in relation to IS, shedding light on the underlying mechanisms that may contribute to this condition. These findings lay a solid foundation for future investigations into targeted prevention strategies.
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Affiliation(s)
- Han Shuai
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Peking University People’s Hospital, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China
| | - Zi Wang
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yinggang Xiao
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yali Ge
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Hua Mao
- Peking University People’s Hospital, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China
| | - Ju Gao
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
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Chen Y, Zhang Y, Wu Q, Chen J, Deng Y. The neuroprotective effect of Chinese herbal medicine for cerebral ischemia reperfusion injury through regulating mitophagy. Front Pharmacol 2024; 15:1378358. [PMID: 38895624 PMCID: PMC11183336 DOI: 10.3389/fphar.2024.1378358] [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: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
The incidence of ischemic stroke has been increasing annually with an unfavorable prognosis. Cerebral ischemia reperfusion injury can exacerbate nerve damage. Effective mitochondrial quality control including mitochondrial fission, fusion and autophagy, is crucial for maintaining cellular homeostasis. Several studies have revealed the critical role of mitophagy in Cerebral ischemia reperfusion injury. Cerebral ischemia and hypoxia induce mitophagy, and mitophagy exhibits positive and negative effects in cerebral ischemia reperfusion injury. Studies have shown that Chinese herbal medicine can alleviate Cerebral ischemia reperfusion injury and serve as a neuroprotective agent by inhibiting or promoting mitophagy-mediated pathways. This review focuses on the mitochondrial dynamics and mitophagy-related pathways, as well as the role of mitophagy in ischemia reperfusion injury. Additionally, it discusses the therapeutic potential and benefits of Chinese herbal monomers and decoctions in the treatment of ischemic stroke.
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Affiliation(s)
- Yanling Chen
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Province Key Laboratory of Cerebrovascular Disease Prevention and Treatment of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yanan Zhang
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Province Key Laboratory of Cerebrovascular Disease Prevention and Treatment of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qin Wu
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Province Key Laboratory of Cerebrovascular Disease Prevention and Treatment of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Jing Chen
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Province Key Laboratory of Cerebrovascular Disease Prevention and Treatment of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yihui Deng
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
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Ding Y, Fang F, Liu X, Sheng S, Li X, Yin X, Chen Z, Wen J. H 2S Regulates the Phenotypic Transformation of Astrocytes Following Cerebral Ischemia/Reperfusion via Inhibiting the RhoA/ROCK Pathway. Mol Neurobiol 2024; 61:3179-3197. [PMID: 37978158 DOI: 10.1007/s12035-023-03797-8] [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: 01/26/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
The role of hydrogen sulfide (H2S) on the phenotypic change of astrocytes following cerebral ischemia/reperfusion (I/R) in mice was investigated in present study. We tested the expression of glial fibrillary acidic protein (GFAP), A2 phenotype marker S100a10, and A1 phenotype marker C3 protein and assessed the change of BrdU/GFAP-positive cells, GFAP/C3-positive cells, and GFAP/S100a10-positive cells in mice hippocampal tissues to evaluate the change of astrocyte phenotypes following cerebral I/R. The role of H2S on the phenotypic change of astrocytes following cerebral I/R in mice was investigated by using H2S synthase cystathionine-γ-lyase (CSE) knockout mice (KO). The results revealed that cerebral I/R injury promoted the astrocytes proliferation of both A1 and A2 phenotypes, which were more significant in mice of H2S synthase CSE KO than in mice of wild type (WT). Interestingly, supplement with H2S could inhibit the A1 phenotype proliferation but promote the proliferation of A2 phenotype, suggesting that H2S could regulate the transformation of astrocytes to A2 phenotype following cerebral I/R, which is beneficial for neuronal recovery. Besides, we found that H2S-mediated change of astrocyte phenotype is related to inhibiting the RhoA/ROCK pathway. Furthermore, both H2S and ROCK inhibitor could ameliorate the brain injury of mice at 9 days after cerebral I/R. In conclusion, H2S regulates the phenotypic transformation of astrocytes to A2 phenotype following the cerebral I/R via inhibiting RhoA/ROCK pathway and then exerts the neuroprotective effect against the subacute brain injury.
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Affiliation(s)
- Yanyu Ding
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Fang Fang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xiaolong Liu
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Shuyan Sheng
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Xueyan Li
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Xiaojiao Yin
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Zhiwu Chen
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China.
| | - Jiyue Wen
- Department of Pharmacology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China.
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